MEDICARE: DR. OM G CHAINANI DMD

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	122300000X	Dentist	057654	NY
2	122300000X	Dentist	22DI02541800	NJ

General Provider Information

NPI Number	:	1447690136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OM G CHAINANI DMD

Provider Business Mailing Address
First Line	:	205 PORT RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1311
Country	:	US
Telephone Number	:	718-727-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 PORT RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1311
Country	:	US
Telephone Number	:	718-727-2555
Fax Number	:

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

Provider Enumeration Date	:	06/27/2013
Last Update Date	:	10/18/2016

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