Basic Information
| Provider Information | |||||||||
| NPI: | 1588694657 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAO | ||||||||
| FirstName: | CHRISTINA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1617 ROUTE 38 | ||||||||
| Address2: | STE. 4 | ||||||||
| City: | LUMBERTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080482919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092610240 | ||||||||
| FaxNumber: | 6092618622 | ||||||||
| Practice Location | |||||||||
| Address1: | 23659 COLUMBUS ROAD | ||||||||
| Address2: | STE. 4 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080221980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092610240 | ||||||||
| FaxNumber: | 6092615181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 10/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25MA04542000 | NJ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 391701 | 05 | NJ | MEDICAID |