Basic Information
Provider Information
NPI: 1942455043
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAO
FirstName: JONG-YI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RPA-C
OtherOrganizationName:  
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OtherCredential:  
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Mailing Information
Address1: 575 LEXINGTON AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100226102
CountryCode: US
TelephoneNumber: 2127467579
FaxNumber: 2127468383
Practice Location
Address1: 520 E 70TH ST
Address2: STARR 341
City: NEW YORK
State: NY
PostalCode: 100219800
CountryCode: US
TelephoneNumber: 2127467576
FaxNumber: 2127468383
Other Information
ProviderEnumerationDate: 11/18/2008
LastUpdateDate: 12/09/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X012996-1NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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