Provider Demographics
NPI:1104121201
Name:MCCONNELL, CHIMERE (NP)
Entity type:Individual
Prefix:
First Name:CHIMERE
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHIMERE
Other - Middle Name:
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:359 REA AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1129
Mailing Address - Country:US
Mailing Address - Phone:917-371-0070
Mailing Address - Fax:
Practice Address - Street 1:2052 TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1560
Practice Address - Country:US
Practice Address - Phone:718-671-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298189164W00000X
NY350717363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No164W00000XNursing Service ProvidersLicensed Practical Nurse