Provider Demographics
NPI:1164459079
Name:CHON, BRIAN H (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:H
Last Name:CHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 CRANBURY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4096
Mailing Address - Country:US
Mailing Address - Phone:732-390-7750
Mailing Address - Fax:732-390-7725
Practice Address - Street 1:103 CEDAR GROVE LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4717
Practice Address - Country:US
Practice Address - Phone:732-631-8233
Practice Address - Fax:732-412-7438
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA074021002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1790396281OtherTITAN HEALTH GROUP NPI#
NJ9092307Medicaid
NJ9092307Medicaid
NJH74914Medicare UPIN