Doctor Name: | CORTNEY CHIAVARO |
NPI Number: | 1013923143 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PAC |
License Number: | 25MP00174300 |
Business Practice Address: | 2101 Rte 34 Wall Township, NJ - 077199104 |
Business Phone Number: | 7329740003 |
Business Fax Number: | 7329704443 |
Mailing Address: | 2101 Route 34, WALL TOWNSHIP |
State: | NJ |
Postal Code: | 077199104 |
Phone Number: | 7329740003 |
Fax Number: | 7329704443 |
NPI Enumeration Date: | 07/31/2006 |
NPI Last Update Date: | 11/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 25MP00174300 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |