MEDICARE: DR. JAY R CHUMSKY D.D.S.

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	122300000X	Dentist	38200	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700099777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY R CHUMSKY D.D.S.

Provider Business Mailing Address
First Line	:	107 LAKE AVE
Second Line	:
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-3915
Country	:	US
Telephone Number	:	914-844-0842
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 LAKE AVE
Second Line	:
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-3915
Country	:	US
Telephone Number	:	914-844-0842
Fax Number	:

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	03/19/2008

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