Provider Demographics
NPI:1316941131
Name:CHASIN, MARC (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:CHASIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FINI TER
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-2511
Mailing Address - Country:US
Mailing Address - Phone:845-783-6699
Mailing Address - Fax:845-783-7641
Practice Address - Street 1:505 ROUTE 208
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1608
Practice Address - Country:US
Practice Address - Phone:845-783-6699
Practice Address - Fax:845-783-7641
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH43467Medicare UPIN
NY4R7151Medicare ID - Type Unspecified