Provider Demographics
NPI:1649227760
Name:CHU, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:CHU
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 1:3401 MARKET ST
Mailing Address - Street 2:SUITE 135
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3315
Mailing Address - Country:US
Mailing Address - Phone:215-387-0550
Mailing Address - Fax:215-387-0556
Practice Address - Street 1:3401 MARKET ST
Practice Address - Street 2:SUITE 135
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3315
Practice Address - Country:US
Practice Address - Phone:215-387-0550
Practice Address - Fax:215-387-0556
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036156L225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007350960001Medicaid
C28433Medicare UPIN
PACH50078Medicare ID - Type Unspecified