Provider Demographics
NPI:1225406127
Name:NEUSTADT, CHANA
Entity Type:Individual
Prefix:
First Name:CHANA
Middle Name:
Last Name:NEUSTADT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 TUDOR CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1471
Mailing Address - Country:US
Mailing Address - Phone:732-905-3817
Mailing Address - Fax:
Practice Address - Street 1:154 TUDOR CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1471
Practice Address - Country:US
Practice Address - Phone:732-905-3817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist