Provider Demographics
NPI:1609044601
Name:CHU, MINDY WEN-JIE
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:WEN-JIE
Last Name:CHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1701
Mailing Address - Country:US
Mailing Address - Phone:718-888-9596
Mailing Address - Fax:718-888-9006
Practice Address - Street 1:3907 PRINCE ST STE 1E
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5321
Practice Address - Country:US
Practice Address - Phone:718-888-9596
Practice Address - Fax:718-888-9006
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist