Provider Demographics
NPI:1437139656
Name:CHU, CLIFFORD T (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:T
Last Name:CHU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1608 ROUTE 88
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3009
Mailing Address - Country:US
Mailing Address - Phone:732-458-8575
Mailing Address - Fax:732-206-0578
Practice Address - Street 1:1608 ROUTE 88
Practice Address - Street 2:SUITE 240
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3009
Practice Address - Country:US
Practice Address - Phone:732-458-8575
Practice Address - Fax:732-206-0578
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2015-01-23
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Provider Licenses
StateLicense IDTaxonomies
NJMA65609207YX0905X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG53272Medicare UPIN
NJ955651MVLMedicare PIN