MEDICARE: DR. CHANTAL THERESA HILAIRE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	220001	NY

General Provider Information

NPI Number	:	1073768958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANTAL THERESA HILAIRE MD

Provider Business Mailing Address
First Line	:	15 MELTON DR E
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-3256
Country	:	US
Telephone Number	:	516-632-9982
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 PUGSLEY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-4408
Country	:	US
Telephone Number	:	718-684-4334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2008
Last Update Date	:	11/19/2008

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