Healthcare Provider Details

I. General information

NPI: 1346285434
Provider Name (Legal Business Name): PHILIPPE CHEMALY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HAMBURG TPKE SUITE 105
WAYNE NJ
07470-2154
US

IV. Provider business mailing address

401 HAMBURG TPKE SUITE 105
WAYNE NJ
07470-2154
US

V. Phone/Fax

Practice location:
  • Phone: 973-595-6066
  • Fax: 973-595-1127
Mailing address:
  • Phone: 973-595-6066
  • Fax: 973-595-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number62518
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: