Provider Demographics
NPI:1912952433
Name:CHAIBONGSAI, UVADEE (MD)
Entity type:Individual
Prefix:
First Name:UVADEE
Middle Name:
Last Name:CHAIBONGSAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 MILLBURN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040
Mailing Address - Country:US
Mailing Address - Phone:973-912-0404
Mailing Address - Fax:973-912-0444
Practice Address - Street 1:2130 MILLBURN AVENUE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040
Practice Address - Country:US
Practice Address - Phone:973-912-0404
Practice Address - Fax:973-912-0444
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA038081002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3615308Medicaid
NJ588037A2VMedicare PIN
NJP00015705Medicare PIN
NJ588037CQHMedicare PIN
C63053Medicare UPIN
NJ3615308Medicaid