Healthcare Provider Details

I. General information

NPI: 1134012404
Provider Name (Legal Business Name): CHANTAL WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3607
US

IV. Provider business mailing address

29 NORWOOD PL
BLOOMFIELD NJ
07003-4013
US

V. Phone/Fax

Practice location:
  • Phone: 201-649-4466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NR16382000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: