Healthcare Provider Details

I. General information

NPI: 1073902961
Provider Name (Legal Business Name): ROVIN CHONIELALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WALNUT ST
SUMMIT NJ
07901-4847
US

IV. Provider business mailing address

113 DUTCH NECK RD
HIGHTSTOWN NJ
08520-4511
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-4800
  • Fax: 609-448-4043
Mailing address:
  • Phone: 609-721-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00222900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00783100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: