Provider Demographics
NPI:1992821615
Name:MUIA-CHISENA, INES (MD)
Entity type:Individual
Prefix:DR
First Name:INES
Middle Name:
Last Name:MUIA-CHISENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 NEW YORK AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4240
Mailing Address - Country:US
Mailing Address - Phone:631-228-5546
Mailing Address - Fax:631-396-4290
Practice Address - Street 1:755 NEW YORK AVE STE 430
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4240
Practice Address - Country:US
Practice Address - Phone:631-228-5546
Practice Address - Fax:631-396-4290
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185082174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF48026Medicare UPIN