Provider Demographics
NPI:1164781175
Name:CHAJSON, ELLEN SUE (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:SUE
Last Name:CHAJSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 ELEANOR DR
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1823
Mailing Address - Country:US
Mailing Address - Phone:732-422-6937
Mailing Address - Fax:
Practice Address - Street 1:114 ELEANOR DR
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1823
Practice Address - Country:US
Practice Address - Phone:732-422-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05321700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E55121Medicare UPIN