Provider Demographics
NPI:1073768958
Name:HILAIRE, CHANTAL THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:THERESA
Last Name:HILAIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MELTON DR E
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3256
Mailing Address - Country:US
Mailing Address - Phone:516-632-9982
Mailing Address - Fax:
Practice Address - Street 1:1310 PUGSLEY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4408
Practice Address - Country:US
Practice Address - Phone:718-684-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220001208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation