Healthcare Provider Details

I. General information

NPI: 1790656759
Provider Name (Legal Business Name): CHRISTOPHER HEYDEL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 ELM AVE
CHESILHURST NJ
08089-1124
US

IV. Provider business mailing address

622 ELM AVE
CHESILHURST NJ
08089-1124
US

V. Phone/Fax

Practice location:
  • Phone: 856-341-0670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR18174400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: