Provider Demographics
NPI:1659363026
Name:CHU, SHU YAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHU
Middle Name:YAN
Last Name:CHU
Suffix:
Gender:M
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:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:SOUTH FALLSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12779-0637
Mailing Address - Country:US
Mailing Address - Phone:845-434-4646
Mailing Address - Fax:845-434-4646
Practice Address - Street 1:41 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:SOUTH FALLSBURG
Practice Address - State:NY
Practice Address - Zip Code:12779-5807
Practice Address - Country:US
Practice Address - Phone:845-434-4646
Practice Address - Fax:845-434-4646
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
914100OtherGHIHMO
NY0021101Medicaid
117177OtherMVP
565941Medicare ID - Type Unspecified
NY0021101Medicaid