Basic Information
| Provider Information | |||||||||
| NPI: | 1316150147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHASIN | ||||||||
| FirstName: | STACIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND ST | ||||||||
| Address2: | FL 3 | ||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457836699 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 STATE ROUTE 208 | ||||||||
| Address2: | SUITE #15 | ||||||||
| City: | MONROE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109501608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457836699 | ||||||||
| FaxNumber: | 8457837641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 06/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 57-011355 | OH | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 253573 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.