Healthcare Provider Details

I. General information

NPI: 1689733610
Provider Name (Legal Business Name): DEWEY A CHANEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 715
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

452 OLD HOOK RD 2ND FLOOR
EMERSON NJ
07630-1381
US

V. Phone/Fax

Practice location:
  • Phone: 201-881-0721
  • Fax: 201-881-0725
Mailing address:
  • Phone: 201-666-3900
  • Fax: 201-261-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA02680800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: