Provider Demographics
NPI:1174517916
Name:CHANIN, ALAN HENRY (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:HENRY
Last Name:CHANIN
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:PO BOX 634
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-0634
Mailing Address - Country:US
Mailing Address - Phone:908-879-6277
Mailing Address - Fax:908-879-4464
Practice Address - Street 1:385 ROUTE 24
Practice Address - Street 2:SUITE 1 C
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2918
Practice Address - Country:US
Practice Address - Phone:908-879-6277
Practice Address - Fax:908-879-4464
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA36221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2095807Medicaid
NJ456437Medicare PIN
C55810Medicare UPIN