Provider Demographics
NPI:1376714881
Name:CHU, ALAN C (DO)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:C
Last Name:CHU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3005
Mailing Address - Country:US
Mailing Address - Phone:585-241-1200
Mailing Address - Fax:585-241-1265
Practice Address - Street 1:217 GRAND ST
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4396
Practice Address - Country:US
Practice Address - Phone:212-965-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400003975Medicare PIN