Healthcare Provider Details

I. General information

NPI: 1558016105
Provider Name (Legal Business Name): BRIAN CHIASSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2022
Last Update Date: 02/12/2022
Certification Date: 02/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 HACKETT BLVD
ALBANY NY
12208-3420
US

IV. Provider business mailing address

7 TOWN GARDEN DR APT 7
LIVERPOOL NY
13088-5531
US

V. Phone/Fax

Practice location:
  • Phone: 518-591-3300
  • Fax:
Mailing address:
  • Phone: 315-729-0497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number619779
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number619779
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: