| Organization Name: | J CALVIN CHATLOS MD LLC |
| NPI Number: | 1417282922 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN CALVIN CHATLOS (SOLE PROPRIETOR) |
| Mailing Address: | 400 W Main St Freehold |
| State: | NJ US |
| Postal Code: | 077282529 |
| Phone Number: | 7324146001 |
| Fax Number: | 7326773149 |
| NPI Enumeration Date: | 10/16/2009 |
| NPI Last Update Date: | 10/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084A0401X |
| License Number: | MA 46262 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |