Basic Information
| Provider Information | |||||||||
| NPI: | 1992734875 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANT | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 MAIDEN CHOICE LN | ||||||||
| Address2: | |||||||||
| City: | CATONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212285968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326432070 | ||||||||
| FaxNumber: | 7326432015 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 ESSEX RD | ||||||||
| Address2: | |||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077532631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326432070 | ||||||||
| FaxNumber: | 7326432015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 09/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 26N007564700 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 7700300 | 05 | NJ | MEDICAID | 8304132 | 01 | EVERCARE | OTHER | 522114204B | 01 | BCBS OF NJ | OTHER |