Healthcare Provider Details

I. General information

NPI: 1396741898
Provider Name (Legal Business Name): LAWRENCE N. CHESSIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 DRIVING PARK AVE
NEWARK NY
14513-1057
US

IV. Provider business mailing address

PO BOX 111 1200 DRIVING PARK AVENUE
NEWARK NY
14513-0111
US

V. Phone/Fax

Practice location:
  • Phone: 315-359-2820
  • Fax: 315-359-2881
Mailing address:
  • Phone: 315-359-2820
  • Fax: 315-359-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number092631
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number092631
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: