Healthcare Provider Details

I. General information

NPI: 1861518243
Provider Name (Legal Business Name): ANDREW J CHASE MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 164TH ST
JAMAICA NY
11432-1118
US

IV. Provider business mailing address

6768 EXETER ST
FOREST HILLS NY
11375-4152
US

V. Phone/Fax

Practice location:
  • Phone: 718-380-3000
  • Fax:
Mailing address:
  • Phone: 718-263-2402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: