Provider Demographics
NPI:1609814094
Name:CHVALA, ROBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:CHVALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N BROAD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1796
Mailing Address - Country:US
Mailing Address - Phone:856-384-0238
Mailing Address - Fax:856-384-4788
Practice Address - Street 1:730 N BROAD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1796
Practice Address - Country:US
Practice Address - Phone:856-384-0238
Practice Address - Fax:856-384-4788
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-025096-E174400000X
NJ25MA03431400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1564609Medicaid
PAB36872Medicare UPIN
PA112102MA9Medicare ID - Type Unspecified