Provider Demographics
NPI:1306472170
Name:CHASE, SHAVAR ALTEREC (APN-BC)
Entity type:Individual
Prefix:MR
First Name:SHAVAR
Middle Name:ALTEREC
Last Name:CHASE
Suffix:
Gender:M
Credentials:APN-BC
Other - Prefix:DR
Other - First Name:SHAVAR
Other - Middle Name:ALTEREC
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN-BC
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-0266
Mailing Address - Country:US
Mailing Address - Phone:862-596-8209
Mailing Address - Fax:
Practice Address - Street 1:1631 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-5144
Practice Address - Country:US
Practice Address - Phone:862-596-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01018500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health