Provider Demographics
NPI:1346285434
Name:CHEMALY, PHILIPPE (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIPPE
Middle Name:
Last Name:CHEMALY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HAMBURG TPKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2154
Mailing Address - Country:US
Mailing Address - Phone:973-595-6066
Mailing Address - Fax:973-595-1127
Practice Address - Street 1:401 HAMBURG TPKE
Practice Address - Street 2:SUITE 105
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2154
Practice Address - Country:US
Practice Address - Phone:973-595-6066
Practice Address - Fax:973-595-1127
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ625182081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7366701Medicaid
NJ901643Medicare ID - Type Unspecified
NJ7366701Medicaid