Provider Demographics
NPI:1659415198
Name:CHAITMAN, EDMUND (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:
Last Name:CHAITMAN
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 1:185 E PALISADE AVE
Mailing Address - Street 2:APT. A6A
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3168
Mailing Address - Country:US
Mailing Address - Phone:201-871-1121
Mailing Address - Fax:
Practice Address - Street 1:185 E PALISADE AVE
Practice Address - Street 2:APT. A6A
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3168
Practice Address - Country:US
Practice Address - Phone:201-871-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA023284002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCH441044Medicare ID - Type Unspecified