Healthcare Provider Details

I. General information

NPI: 1912088840
Provider Name (Legal Business Name): ERNEST C CHISENA MD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CENTERPORT ROAD
CENTERPORT NY
11721
US

IV. Provider business mailing address

101 CENTERPORT ROAD
CENTERPORT NY
11721
US

V. Phone/Fax

Practice location:
  • Phone: 631-261-0110
  • Fax: 631-261-7984
Mailing address:
  • Phone: 631-261-0110
  • Fax: 631-261-7984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number132029
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: