Provider Demographics
NPI:1134345309
Name:CHIN CAMACHO, JUNELLA (DO)
Entity type:Individual
Prefix:DR
First Name:JUNELLA
Middle Name:
Last Name:CHIN CAMACHO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 MADISON AVE
Mailing Address - Street 2:1000
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5110
Mailing Address - Country:US
Mailing Address - Phone:212-966-6655
Mailing Address - Fax:212-966-6226
Practice Address - Street 1:171 MADISON AVE
Practice Address - Street 2:1000
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5110
Practice Address - Country:US
Practice Address - Phone:212-966-6655
Practice Address - Fax:212-966-6226
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine