1699385021 NPI number — CHESS MEDICINE PLLC

Table of content: (NPI 1699385021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699385021 NPI number — CHESS MEDICINE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESS MEDICINE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699385021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 HEMION RD STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEBELLO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10901-4919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-666-8145
Provider Business Mailing Address Fax Number:
203-456-9793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 HEMION RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEBELLO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10901-4919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-666-8145
Provider Business Practice Location Address Fax Number:
203-456-9793
Provider Enumeration Date:
07/31/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHESS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-666-8145

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LG0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05875296 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".