Provider Demographics
NPI:1245236611
Name:YU, JIAN CHU (MD)
Entity Type:Individual
Prefix:DR
First Name:JIAN
Middle Name:CHU
Last Name:YU
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 1:236 CEDRUS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4515
Mailing Address - Country:US
Mailing Address - Phone:631-368-1142
Mailing Address - Fax:631-368-1113
Practice Address - Street 1:227 MOUNT PLEASANT ROAD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2900
Practice Address - Country:US
Practice Address - Phone:631-360-0005
Practice Address - Fax:631-368-1113
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144252208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0054209OtherGHI
NY020023863OtherRR MEDICARE
NYDO8585OtherOXFORD
NY0614257-005OtherCIGNA
NY11632OtherVYTRA
NY27153POtherHIP
NY56A913OtherBCBS
NY144252B28OtherHEALTH FIRST
NY40C2983OtherHEALTHNET
NY112219566OtherEMPIRE PLAN, NYSHIP
NY1168009OtherUNITED HEALTH CARE
NY144252OtherHIP
NY1442525OtherHEALTHCARE PARTNER
NY183279OtherAETNA
NY112219566OtherCIGNA
NYA63271Medicare UPIN
NY56A911Medicare ID - Type Unspecified