Provider Demographics
NPI:1568796175
Name:CHIU, HERMAN (DO)
Entity Type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:
Last Name:CHIU
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 1:484 TEMPLE HILL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5557
Mailing Address - Country:US
Mailing Address - Phone:845-565-3700
Mailing Address - Fax:845-565-3696
Practice Address - Street 1:484 TEMPLE HILL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5557
Practice Address - Country:US
Practice Address - Phone:845-565-3700
Practice Address - Fax:845-565-3696
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013044207P00000X, 207R00000X
NY266811207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03577786Medicaid
NY03577786Medicaid