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General NPI Number Information
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NPI Number | 1073257879
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Entity Type | Individual
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Provider Name | CHANELLE C DURAND MD
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Gender | Female
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 988 BROADWAY
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City | BAYONNE
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State | NJ
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Zip | 07002-4036
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Country | US
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Telephone | 201-339-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 WOODBRIDGE COMMONS WAY
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City | ISELIN
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State | NJ
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Zip | 08830-3028
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Country | US
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Telephone | 717-719-9858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA12683200
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License Number State | NJ
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