Healthcare Provider Details

I. General information

NPI: 1316150147
Provider Name (Legal Business Name): STACIE CHASIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BENTON AVE
MIDDLETOWN NY
10940-5177
US

IV. Provider business mailing address

2570 ROUTE 9W STE 10
CORNWALL NY
12518-1370
US

V. Phone/Fax

Practice location:
  • Phone: 845-563-8000
  • Fax:
Mailing address:
  • Phone: 845-220-3100
  • Fax: 845-534-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number253573
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: