Provider Demographics
NPI:1083643209
Name:CHEZ, MENCIO ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:MENCIO
Middle Name:ANTONIO
Last Name:CHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1089 KINKEAD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2840
Mailing Address - Country:US
Mailing Address - Phone:716-694-6284
Mailing Address - Fax:716-694-1322
Practice Address - Street 1:1089 KINKEAD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2840
Practice Address - Country:US
Practice Address - Phone:716-694-6284
Practice Address - Fax:716-694-1322
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193588-1207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2207119OtherINDEPENDENT HEALTH
NY000523652002OtherBLUE CROSS BLUE SHIELD
NY00010029601OtherUNIVERA
NY01814020Medicaid
NY00010029601OtherUNIVERA
NY01814020Medicaid