Provider Demographics
NPI:1154383008
Name:CHACON, JAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:CHACON
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 TAYLORS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3326
Mailing Address - Country:US
Mailing Address - Phone:718-448-6800
Mailing Address - Fax:718-448-9458
Practice Address - Street 1:800 MANOR RD
Practice Address - Street 2:SUITE 4
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7034
Practice Address - Country:US
Practice Address - Phone:718-448-6800
Practice Address - Fax:718-448-9458
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02023930Medicaid
NYH21891Medicare UPIN
NY857291Medicare ID - Type Unspecified