Provider Demographics
NPI:1730363011
Name:CHUA, JARED NIGEL BANTING
Entity type:Individual
Prefix:
First Name:JARED NIGEL
Middle Name:BANTING
Last Name:CHUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1903
Mailing Address - Country:US
Mailing Address - Phone:908-922-1344
Mailing Address - Fax:
Practice Address - Street 1:17 CONCORD RD
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1903
Practice Address - Country:US
Practice Address - Phone:908-922-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-22
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist