Provider Demographics
NPI:1538138664
Name:RAPPAPORT, CHAD W (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:W
Last Name:RAPPAPORT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 FRANKLIN AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1306
Mailing Address - Country:US
Mailing Address - Phone:201-560-0711
Mailing Address - Fax:201-560-0712
Practice Address - Street 1:784 FRANKLIN AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1306
Practice Address - Country:US
Practice Address - Phone:201-560-0711
Practice Address - Fax:201-560-0712
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00298500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1011407330001Medicaid
NJ1011407330001Medicaid
NJ085825Medicare PIN