Provider Demographics
NPI:1225175011
Name:CHA, JAEOK (MD)
Entity Type:Individual
Prefix:MRS
First Name:JAEOK
Middle Name:
Last Name:CHA
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 1:45 HOMESTEAD DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022
Mailing Address - Country:US
Mailing Address - Phone:609-291-1535
Mailing Address - Fax:609-291-1235
Practice Address - Street 1:45 HOMESTEAD DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022
Practice Address - Country:US
Practice Address - Phone:609-291-1535
Practice Address - Fax:609-291-1235
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA475832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1927604Medicaid
E52532Medicare UPIN
NJ1927604Medicaid