Provider Demographics
NPI:1902990872
Name:CHIU, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:CHIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 BROADWAY # LLB
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-8200
Mailing Address - Country:US
Mailing Address - Phone:212-296-5777
Mailing Address - Fax:212-761-4758
Practice Address - Street 1:1585 BROADWAY # LLB
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-8200
Practice Address - Country:US
Practice Address - Phone:212-296-5777
Practice Address - Fax:212-761-4758
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY238361OtherLICENSE