Provider Demographics
NPI:1366409476
Name:CHONG, JOSEPH KYU (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KYU
Last Name:CHONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1326
Mailing Address - Country:US
Mailing Address - Phone:973-227-5195
Mailing Address - Fax:201-461-5773
Practice Address - Street 1:44 SYLVAN AVE
Practice Address - Street 2:SUITE # 2A
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2426
Practice Address - Country:US
Practice Address - Phone:201-461-5770
Practice Address - Fax:201-461-5773
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06002800207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7146108Medicaid
NJ7146108Medicaid
NJG36559Medicare UPIN