Provider Demographics
NPI:1790367217
Name:CHIU, EDITH Y
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:Y
Last Name:CHIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6238
Mailing Address - Country:US
Mailing Address - Phone:201-947-8988
Mailing Address - Fax:201-664-0905
Practice Address - Street 1:653 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIVER VALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6238
Practice Address - Country:US
Practice Address - Phone:201-664-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO1437000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist