Healthcare Provider Details

I. General information

NPI: 1740164979
Provider Name (Legal Business Name): CENTRAL NY NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N MAIN ST STE 201
NEW CITY NY
10956-3850
US

IV. Provider business mailing address

1342 VENTURA DR
LAKEWOOD NJ
08701-2261
US

V. Phone/Fax

Practice location:
  • Phone: 732-305-2825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHANA CHAPLER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 732-305-2825