Provider Demographics
NPI:1730577909
Name:CHAN, JADE (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:JADE
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60-2 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2286
Mailing Address - Country:US
Mailing Address - Phone:732-609-1232
Mailing Address - Fax:
Practice Address - Street 1:481 MEMORIAL PKWY STE 2
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1766
Practice Address - Country:US
Practice Address - Phone:732-321-7056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01563100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist