Healthcare Provider Details

I. General information

NPI: 1407108780
Provider Name (Legal Business Name): FAYEZ FADI CHAHFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 GENESEE ST SUITE 301
UTICA NY
13502-5829
US

IV. Provider business mailing address

2206 GENESEE ST SUITE 301
UTICA NY
13502-5829
US

V. Phone/Fax

Practice location:
  • Phone: 315-792-4623
  • Fax: 315-792-6901
Mailing address:
  • Phone: 315-792-4623
  • Fax: 315-792-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number197706-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001910-57
License Number StateNY

VIII. Authorized Official

Name: DR. FAYEZ F CHAHFE
Title or Position: OWNER
Credential: MD
Phone: 315-792-4623