MEDICARE: DR. LAWRENCE N. CHESSIN M.D.

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	207RI0200X	Infectious Disease Physician	092631	NY
2	207R00000X	Internal Medicine Physician	092631	NY

General Provider Information

NPI Number	:	1396741898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE N. CHESSIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 111
Second Line	:	1200 DRIVING PARK AVENUE
City	:	NEWARK
State	:	NY
Zip	:	14513-0111
Country	:	US
Telephone Number	:	315-359-2820
Fax Number	:	315-359-2881

Provider Business Practice Location Address
First Line	:	1200 DRIVING PARK AVE
Second Line	:
City	:	NEWARK
State	:	NY
Zip	:	14513-1057
Country	:	US
Telephone Number	:	315-359-2820
Fax Number	:	315-359-2881

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	12/13/2013

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