Provider Demographics
NPI:1861469033
Name:CHICHETTI, JOANNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:CHICHETTI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LYONS AVE
Mailing Address - Street 2:SUITE L4
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2027
Mailing Address - Country:US
Mailing Address - Phone:973-926-7205
Mailing Address - Fax:973-923-8993
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:SUITE L4
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7205
Practice Address - Fax:973-923-8993
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN10419500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8639108Medicaid
NJ8639108Medicaid