Provider Demographics
NPI:1790084663
Name:CHO, JAE ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:JAE
Middle Name:ROBERTO
Last Name:CHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CANCER AND BLOOD MEDICAL SERVICES OF NY
Mailing Address - Street 2:2 LONGVIEW AVENUE SUITE 300
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601
Mailing Address - Country:US
Mailing Address - Phone:914-849-7630
Mailing Address - Fax:
Practice Address - Street 1:2 LONGVIEW AVE STE 300
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-5012
Practice Address - Country:US
Practice Address - Phone:914-849-7630
Practice Address - Fax:914-849-7694
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY267585207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03868471Medicaid