Healthcare Provider Details

I. General information

NPI: 1366494262
Provider Name (Legal Business Name): KENNETH B CHAPMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 HYLAN BLVD
STATEN ISLAND NY
10305-1922
US

IV. Provider business mailing address

1360 HYLAN BLVD
STATEN ISLAND NY
10305-1922
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-3577
  • Fax:
Mailing address:
  • Phone: 718-667-3577
  • Fax: 347-875-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number233952
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number233952
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: