MEDICARE: MR. LARRY BERNARD CHASIN

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	103TC0700X	Clinical Psychologist	355100082200	NJ
2	103TC0700X	Clinical Psychologist	003236 1	NY

General Provider Information

NPI Number	:	1588654156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY BERNARD CHASIN

Provider Business Mailing Address
First Line	:	155 COUNTY RD
Second Line	:
City	:	CRESSKILL
State	:	NJ
Zip	:	07626-2200
Country	:	US
Telephone Number	:	201-567-5609
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 COUNTY RD
Second Line	:
City	:	CRESSKILL
State	:	NJ
Zip	:	07626-2200
Country	:	US
Telephone Number	:	201-567-5609
Fax Number	:

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. LARRY BERNARD CHASIN ” Practice Location

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