Provider Demographics
NPI:1154856755
Name:CHUA, JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:CHUA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 CLOCK TOWER CMNS
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4055
Mailing Address - Country:US
Mailing Address - Phone:845-279-5187
Mailing Address - Fax:845-279-5168
Practice Address - Street 1:400 WESTAGE BUSINESS CTR DR STE 211
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2267
Practice Address - Country:US
Practice Address - Phone:845-471-3500
Practice Address - Fax:877-546-3181
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT212671207Q00000X
NY306036-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07085129Medicaid