1811011653 NPI number — WAYNE S CHANLER, DMD, PC

Table of content: (NPI 1811011653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811011653 NPI number — WAYNE S CHANLER, DMD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE S CHANLER, DMD, PC
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:
1811011653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14512-0308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-374-6323
Provider Business Mailing Address Fax Number:
585-374-6324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-374-6323
Provider Business Practice Location Address Fax Number:
585-374-6324
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHANLER
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
585-374-6323

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  032121 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5828183 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 032121 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00464291 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32121 . This is a "CSEA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7710 . This is a "EXCELLUS BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com