Healthcare Provider Details

I. General information

NPI: 1801567656
Provider Name (Legal Business Name): ALEXANDER CHIANESE APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ROUTE 70 E BLDG A100
MARLTON NJ
08053-2341
US

IV. Provider business mailing address

765 ROUTE 70 E BLDG A100
MARLTON NJ
08053-2341
US

V. Phone/Fax

Practice location:
  • Phone: 856-797-4721
  • Fax: 856-797-4785
Mailing address:
  • Phone: 856-797-4721
  • Fax: 856-797-4785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR19538800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01210900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: