Basic Information
| Provider Information | |||||||||
| NPI: | 1477147585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHIU | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | CHUN LONG | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 W 168TH ST # 4 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123053273 | ||||||||
| FaxNumber: | 2123056692 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 AUDUBON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100322248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123053273 | ||||||||
| FaxNumber: | 2123056692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2021 | ||||||||
| LastUpdateDate: | 07/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 346133 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.