Provider Demographics
NPI:1295828911
Name:CHABUS, BRENT IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:IRA
Last Name:CHABUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10 SWANS MILL LN
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-3406
Mailing Address - Country:US
Mailing Address - Phone:212-477-5698
Mailing Address - Fax:917-677-6621
Practice Address - Street 1:161 MADISON AVE
Practice Address - Street 2:SUITE 10NW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5421
Practice Address - Country:US
Practice Address - Phone:212-477-5698
Practice Address - Fax:212-696-9411
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1682332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01143402Medicaid
NY20F321Medicare ID - Type Unspecified