Basic Information
| Provider Information | |||||||||
| NPI: | 1639165194 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHIU | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | RIVERSIDE ASSOCIATES IN ANESTHESIA | ||||||||
| Address2: | 40 FRONT STREET | ||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077227264 | ||||||||
| FaxNumber: | 6077227869 | ||||||||
| Practice Location | |||||||||
| Address1: | RIVERSIDE ASSOCIATES IN ANESTHESIA | ||||||||
| Address2: | 40 FRONT STREET | ||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077227264 | ||||||||
| FaxNumber: | 6077227869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | BC1347423 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | CAN174038 | 01 | NY | WORKERS COMP | OTHER | 01078000 | 05 | NY | MEDICAID |