Healthcare Provider Details

I. General information

NPI: 1255684023
Provider Name (Legal Business Name): NORMAN CHAZIN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 NEW RD STE 61A
LINWOOD NJ
08221-2029
US

IV. Provider business mailing address

199 NEW RD STE 61A
LINWOOD NJ
08221-2029
US

V. Phone/Fax

Practice location:
  • Phone: 609-926-7001
  • Fax: 609-926-7004
Mailing address:
  • Phone: 609-926-7001
  • Fax: 609-926-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number25MA04602100
License Number StateNJ

VIII. Authorized Official

Name: NORMAN CHAZIN
Title or Position: OWNER
Credential: MD
Phone: 609-705-3221