Provider Demographics
NPI:1841231016
Name:CHIANG, CARY H (MD)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:H
Last Name:CHIANG
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 1:307 SOUTH EVERGREEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096
Mailing Address - Country:US
Mailing Address - Phone:201-289-6803
Mailing Address - Fax:201-891-8308
Practice Address - Street 1:30 PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:551-996-4614
Practice Address - Fax:201-968-1866
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06927400207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG98215Medicare UPIN
G98215Medicare UPIN
028684DHKMedicare PIN