Provider Demographics
NPI:1881169985
Name:CHIONG, JACQUELINE KO
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:KO
Last Name:CHIONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 CHATHAM DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-8847
Mailing Address - Country:US
Mailing Address - Phone:732-618-6290
Mailing Address - Fax:
Practice Address - Street 1:901 ROUTE 73 N STE C
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1226
Practice Address - Country:US
Practice Address - Phone:856-581-9711
Practice Address - Fax:856-581-9712
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00859300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily