Provider Demographics
NPI:1629160221
Name:CHIANG, BESSIE (MD)
Entity Type:Individual
Prefix:
First Name:BESSIE
Middle Name:
Last Name:CHIANG
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 1:17 SYLVAN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2037
Mailing Address - Country:US
Mailing Address - Phone:201-507-1010
Mailing Address - Fax:201-507-5900
Practice Address - Street 1:17 SYLVAN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2037
Practice Address - Country:US
Practice Address - Phone:201-507-1010
Practice Address - Fax:201-507-5900
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04932500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE55116Medicare UPIN
NJ613695Medicare ID - Type Unspecified