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General NPI Number Information
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NPI Number | 1982774667
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Entity Type | Organization
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Legal Business Name | JEFFREY B. CHICK M.D.P.C.
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 5528 LEGIONNIRE DRIVE
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City | CICERO
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State | NY
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Zip | 13209-2228
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Country | US
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Telephone | 315-579-2760
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Fax | 315-579-2761
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Provider Business Mailing Address
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Address Line | 5528 LEGIONNAIRE DRIVE
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City | CICERO
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State | NY
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Zip | 13209-2228
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Country | US
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Telephone | 315-579-2760
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Fax | 315-579-2761
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY BEECHAM CHICK
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Credential | M.D.
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Telephone | 315-579-2760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 127721-1
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License Number State | NY
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