MEDICARE: MARC CHASIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	221393	NY

General Provider Information

NPI Number	:	1316941131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC CHASIN M.D.

Provider Business Mailing Address
First Line	:	18 FINI TER
Second Line	:
City	:	CHESTER
State	:	NY
Zip	:	10918-2511
Country	:	US
Telephone Number	:	845-783-6699
Fax Number	:	845-783-7641

Provider Business Practice Location Address
First Line	:	505 ROUTE 208
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-1608
Country	:	US
Telephone Number	:	845-783-6699
Fax Number	:	845-783-7641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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