Provider Demographics
NPI:1689812505
Name:CHIESA, DREW JONATHAN
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:JONATHAN
Last Name:CHIESA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 FRIES MILL RD
Mailing Address - Street 2:SUITE N-1
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2015
Mailing Address - Country:US
Mailing Address - Phone:856-783-2241
Mailing Address - Fax:856-783-2243
Practice Address - Street 1:188 FRIES MILL RD
Practice Address - Street 2:SUITE N-1
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2015
Practice Address - Country:US
Practice Address - Phone:856-783-2241
Practice Address - Fax:856-783-2243
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MB08874300207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program