Provider Demographics
NPI:1235344110
Name:CHIN, STEPHANIE E (MD)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:E
Last Name:CHIN
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 1:212 YALE BLVD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4054
Mailing Address - Country:US
Mailing Address - Phone:716-860-8184
Mailing Address - Fax:
Practice Address - Street 1:1623 ROUTE 88 W STE A
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3048
Practice Address - Country:US
Practice Address - Phone:732-458-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.011565208000000X
OH35-093271208000000X
NY60-255795208000000X
NJ25MA092548002080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2951202Medicaid
OHCH4263631Medicare PIN