Provider Demographics
NPI:1497857635
Name:CHIUMENTO, MARVIN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:JOSEPH
Last Name:CHIUMENTO
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 1:20 COMMUNITY PL STE 105
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7501
Mailing Address - Country:US
Mailing Address - Phone:973-538-4544
Mailing Address - Fax:973-538-3703
Practice Address - Street 1:20 COMMUNITY PL STE 105
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7501
Practice Address - Country:US
Practice Address - Phone:973-538-4544
Practice Address - Fax:973-538-3703
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07226800207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0326453Medicaid
NJ0326453Medicaid