Provider Demographics
NPI:1891867248
Name:CHUMAK, LUDMILA (PA-C)
Entity Type:Individual
Prefix:
First Name:LUDMILA
Middle Name:
Last Name:CHUMAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 S HARDING HWY
Mailing Address - Street 2:
Mailing Address - City:BUENA
Mailing Address - State:NJ
Mailing Address - Zip Code:08310-9732
Mailing Address - Country:US
Mailing Address - Phone:856-697-0111
Mailing Address - Fax:856-697-0003
Practice Address - Street 1:761 SOUTH HARDING HWY
Practice Address - Street 2:
Practice Address - City:BUENA
Practice Address - State:NJ
Practice Address - Zip Code:08310
Practice Address - Country:US
Practice Address - Phone:856-697-0111
Practice Address - Fax:856-697-0003
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10004552363AM0700X
NJ25MP0038600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical