Provider Demographics
NPI:1669429346
Name:CHASE, HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:CHASE
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 1:545 W 111TH ST
Mailing Address - Street 2:APT # 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1982
Mailing Address - Country:US
Mailing Address - Phone:201-996-4614
Mailing Address - Fax:201-968-1866
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:ETD
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1914
Practice Address - Country:US
Practice Address - Phone:201-996-4614
Practice Address - Fax:201-968-1866
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06837500207P00000X
NY1457131207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF30350Medicare UPIN
NJ025018DHKMedicare ID - Type Unspecified