Provider Demographics
NPI:1578728176
Name:BORNSTEIN-CHAU, JUDITH AVIVA (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:AVIVA
Last Name:BORNSTEIN-CHAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 HOLME AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2007
Mailing Address - Country:US
Mailing Address - Phone:215-335-6051
Mailing Address - Fax:215-335-6303
Practice Address - Street 1:2601 HOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2007
Practice Address - Country:US
Practice Address - Phone:215-335-6051
Practice Address - Fax:215-335-6303
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435148207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022752470002Medicaid
PA1022752470001Medicaid
PA3712796000OtherINDEPENDENCE BLUE CROSS
PA102275247-0003Medicaid
PA2089041OtherHIGHMARK BLUE SHIELD
PA144613Medicare PIN