Provider Demographics
NPI:1336190560
Name:CHAZEN, DIANE ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:ROBIN
Last Name:CHAZEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MORRIS AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1426
Mailing Address - Country:US
Mailing Address - Phone:973-379-8900
Mailing Address - Fax:973-379-0580
Practice Address - Street 1:55 MORRIS AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1426
Practice Address - Country:US
Practice Address - Phone:973-379-8900
Practice Address - Fax:973-379-0580
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04305400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ442521Medicare ID - Type Unspecified
NJC54600Medicare UPIN