Provider Demographics
NPI:1558460527
Name:CHAO, CHIA-YU (MD)
Entity Type:Individual
Prefix:
First Name:CHIA-YU
Middle Name:
Last Name:CHAO
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 1:14 JASON PL
Mailing Address - Street 2:STE 201
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-1909
Mailing Address - Country:US
Mailing Address - Phone:845-800-5118
Mailing Address - Fax:845-625-1735
Practice Address - Street 1:539 EGG HARBOR RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2371
Practice Address - Country:US
Practice Address - Phone:856-582-8885
Practice Address - Fax:856-582-6556
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305130-01208000000X
NJ25MA05425700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ382750001Medicaid