Provider Demographics
NPI:1487695961
Name:CHAIT, EVAN M (PT)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:M
Last Name:CHAIT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2089
Mailing Address - Country:US
Mailing Address - Phone:201-327-1990
Mailing Address - Fax:201-327-1921
Practice Address - Street 1:171 LAKE ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2089
Practice Address - Country:US
Practice Address - Phone:201-327-1990
Practice Address - Fax:201-327-1921
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00862800225100000X
NJ25MZ00070600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ042850Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
NJ042850U96Medicare UPIN