Basic Information
| Provider Information | |||||||||
| NPI: | 1003030198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEN | ||||||||
| FirstName: | YU-CHI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 SUNSET AVE | ||||||||
| Address2: | |||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088203039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325481255 | ||||||||
| FaxNumber: | 7325481255 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 BERGEN ST | ||||||||
| Address2: | DOC # 3300, UMDNJ | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739722800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 40QA01168300 | NJ | Y | Hospitals | General Acute Care Hospital |
No ID Information.