Healthcare Provider Details

I. General information

NPI: 1275452971
Provider Name (Legal Business Name): JAIDEN CHAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 BROAD ST
NEWARK NJ
07102-4415
US

IV. Provider business mailing address

317 EAST ST
BOUND BROOK NJ
08805-2012
US

V. Phone/Fax

Practice location:
  • Phone: 973-434-5081
  • Fax:
Mailing address:
  • Phone: 347-537-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: