Healthcare Provider Details

I. General information

NPI: 1487530192
Provider Name (Legal Business Name): ALEJANDRA T CHACON BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 WILLOW AVE
ROCKAWAY NJ
07866-2825
US

IV. Provider business mailing address

49 WILLOW AVE
ROCKAWAY NJ
07866-2825
US

V. Phone/Fax

Practice location:
  • Phone: 973-262-6402
  • Fax:
Mailing address:
  • Phone: 973-262-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR20108200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: