Basic Information
| Provider Information | |||||||||
| NPI: | 1750585287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHU | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | TIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 ROUTE 112 BLDG 4 | ||||||||
| Address2: | |||||||||
| City: | PORT JEFFERSON STATION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117768055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317513000 | ||||||||
| FaxNumber: | 6316752001 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 NESCONSET HWY | ||||||||
| Address2: | |||||||||
| City: | PORT JEFFERSON STATION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117762628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317513000 | ||||||||
| FaxNumber: | 6316752001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 250808 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 03094680 | 05 | NY | MEDICAID | 11303 | 01 | NY | MAGNACARE | OTHER | 7C2423 | 01 | NY | HEALTHNET | OTHER | 014CE1 | 01 | NY | BLUE SHIELD | OTHER | 250808-A10 | 01 | NY | HEALTHFIRST | OTHER | 8259306 | 01 | NY | CIGNA | OTHER | 091202000087 | 01 | NY | FIDELIS CARE OF NY | OTHER | P00750946 | 01 | NY | RR MEDICARE | OTHER | P4082661 | 01 | NY | OXFORD | OTHER | 201009000016 | 01 | NY | AFFINITY | OTHER | 4584734 | 01 | NY | AETNA | OTHER |