Provider Demographics
NPI:1770687006
Name:JEAN, JONG CHU (MD)
Entity Type:Individual
Prefix:DR
First Name:JONG
Middle Name:CHU
Last Name:JEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:250 YAPHANK ROAD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-654-2266
Mailing Address - Fax:631-654-1122
Practice Address - Street 1:250 YAPHANK ROAD
Practice Address - Street 2:SUITE 16
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-654-2266
Practice Address - Fax:631-654-1122
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY128588207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00629658Medicaid
NY312391OtherBCBS
NY312391Medicare ID - Type Unspecified
NY312391OtherBCBS