Provider Demographics
NPI:1710991245
Name:CHIU, CHINTA TONY (MD)
Entity Type:Individual
Prefix:
First Name:CHINTA
Middle Name:TONY
Last Name:CHIU
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 1:13360 41ST AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5811
Mailing Address - Country:US
Mailing Address - Phone:718-886-1664
Mailing Address - Fax:718-886-1943
Practice Address - Street 1:13360 41ST AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5811
Practice Address - Country:US
Practice Address - Phone:718-886-1664
Practice Address - Fax:718-886-1943
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01997502Medicaid
03774OtherGHI
50C247OtherBCBS
G99247Medicare UPIN