Provider Demographics
NPI:1972104784
Name:CHASSE, JILL DIANA (PHD, DRPH, ND, IMD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:DIANA
Last Name:CHASSE
Suffix:
Gender:F
Credentials:PHD, DRPH, ND, IMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 BELLE TERRE RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2324
Mailing Address - Country:US
Mailing Address - Phone:202-230-4126
Mailing Address - Fax:
Practice Address - Street 1:70 PARK ST STE 208
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2960
Practice Address - Country:US
Practice Address - Phone:202-230-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No175M00000XOther Service ProvidersMidwife, Lay
No176B00000XOther Service ProvidersMidwife
No246ZG1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGeneticist, Medical (PhD)
No251K00000XAgenciesPublic Health or Welfare
No374J00000XNursing Service Related ProvidersDoula