Basic Information
| Provider Information | |||||||||
| NPI: | 1811936842 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHINIGO | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WEITZENFELD | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | SUE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 277 FOREST AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076525410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019861881 | ||||||||
| FaxNumber: | 2019861871 | ||||||||
| Practice Location | |||||||||
| Address1: | 277 FOREST AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076525410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019861881 | ||||||||
| FaxNumber: | 2019861871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | X | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MA072553 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.