Provider Demographics
NPI:1891800405
Name:CHAN, ALBERT CUA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:CUA
Last Name:CHAN
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 1:2301 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5418
Mailing Address - Country:US
Mailing Address - Phone:908-754-9600
Mailing Address - Fax:908-754-2043
Practice Address - Street 1:2301 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5418
Practice Address - Country:US
Practice Address - Phone:908-754-9600
Practice Address - Fax:908-754-2043
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA50495207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE62723Medicare UPIN