Provider Demographics
NPI:1316839673
Name:LACHAPELLE, CLIFF GUS
Entity type:Individual
Prefix:
First Name:CLIFF
Middle Name:GUS
Last Name:LACHAPELLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1334
Mailing Address - Country:US
Mailing Address - Phone:347-753-5921
Mailing Address - Fax:
Practice Address - Street 1:1458 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-1334
Practice Address - Country:US
Practice Address - Phone:347-753-5921
Practice Address - Fax:347-753-5921
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR19114400163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty