1881060465 NPI number — DAVID CHESSEN DPT

Table of content: DAVID CHESSEN DPT (NPI 1881060465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881060465 NPI number — DAVID CHESSEN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHESSEN
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

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:
1881060465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
138 HOPMEADOW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEATOGUE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06089-9793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-413-2073
Provider Business Mailing Address Fax Number:
860-413-2081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
72 ROUTE 27
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDISON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08820-3986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-662-9901
Provider Business Practice Location Address Fax Number:
732-662-9904
Provider Enumeration Date:
08/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  09183 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 40QA01693100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1174173 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com