Provider Demographics
NPI:1992746218
Name:CHASIN, MITCHELL C (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:C
Last Name:CHASIN
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 1:350 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2833
Mailing Address - Country:US
Mailing Address - Phone:908-231-0777
Mailing Address - Fax:908-722-6031
Practice Address - Street 1:350 GROVE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2833
Practice Address - Country:US
Practice Address - Phone:908-231-0777
Practice Address - Fax:908-722-6031
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA48590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD20091Medicare UPIN
CH405644Medicare ID - Type Unspecified