Provider Demographics
NPI:1073902961
Name:CHONIELALL, ROVIN
Entity Type:Individual
Prefix:
First Name:ROVIN
Middle Name:
Last Name:CHONIELALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 DUTCH NECK RD
Mailing Address - Street 2:
Mailing Address - City:HIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-4511
Mailing Address - Country:US
Mailing Address - Phone:609-721-2255
Mailing Address - Fax:
Practice Address - Street 1:2 WALNUT ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4847
Practice Address - Country:US
Practice Address - Phone:908-522-4800
Practice Address - Fax:609-448-4043
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00222900101YA0400X
NJ37PC00783100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty