Provider Demographics
NPI:1588751093
Name:CHIN, JERRY (DO)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:CHIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3 NANCY DR
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782
Mailing Address - Country:US
Mailing Address - Phone:631-517-9547
Mailing Address - Fax:631-517-9547
Practice Address - Street 1:760 SUNRISE HIGHWAY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704
Practice Address - Country:US
Practice Address - Phone:631-517-9547
Practice Address - Fax:631-517-9547
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY221368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4C8783OtherHEALTHNET
NY8C9721OtherBC/BS
NY221368-30OtherHEALTH FIRST
NY5997110OtherGHI
NY133994OtherVYTRA
NYP2695103OtherOXFORD
NY6009146OtherCIGNA
NY6009146OtherCIGNA
NY133994OtherVYTRA