Provider Demographics
NPI:1518073782
Name:CHIU, KENNY (MD)
Entity Type:Individual
Prefix:
First Name:KENNY
Middle Name:
Last Name:CHIU
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 1:525 JACK MARTIN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-840-0067
Mailing Address - Fax:732-840-3169
Practice Address - Street 1:525 JACK MARTIN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-840-0067
Practice Address - Fax:732-840-3169
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07873100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0070866Medicaid
I28458Medicare UPIN
NJ090427NY6Medicare ID - Type Unspecified