Provider Demographics
NPI:1225063456
Name:DEYOUNG, CHAD M (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:M
Last Name:DEYOUNG
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 1:109 WANAQUE AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-2101
Mailing Address - Country:US
Mailing Address - Phone:862-666-9200
Mailing Address - Fax:862-666-9204
Practice Address - Street 1:223 N VAN DIEN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2726
Practice Address - Country:US
Practice Address - Phone:201-634-5403
Practice Address - Fax:201-252-8472
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPENDING2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology