Provider Demographics
NPI:1255432621
Name:GRACE U CHUNG MD PC
Entity type:Organization
Organization Name:GRACE U CHUNG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:U
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-853-0900
Mailing Address - Street 1:17 W RED BANK AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1630
Mailing Address - Country:US
Mailing Address - Phone:856-853-0900
Mailing Address - Fax:856-853-5838
Practice Address - Street 1:17 W RED BANK AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-853-0900
Practice Address - Fax:856-853-5838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55490207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0543745000OtherAMERIHEALTH GROUP #
NJ197180801Medicaid
NJ24034OtherAETNA GROUP #
NJ271880OtherAMERIHEALTH PPO GROUP #
NJ271880OtherAMERIHEALTH PPO GROUP #
NJ24034OtherAETNA GROUP #
NJH63365Medicare UPIN
NJ0543745000OtherAMERIHEALTH GROUP #
NJE70279Medicare UPIN