Provider Demographics
NPI:1083729354
Name:TSE, CHISAI (DO)
Entity Type:Individual
Prefix:
First Name:CHISAI
Middle Name:
Last Name:TSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6323 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4742
Mailing Address - Country:US
Mailing Address - Phone:718-283-6980
Mailing Address - Fax:718-635-6750
Practice Address - Street 1:6323 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4742
Practice Address - Country:US
Practice Address - Phone:718-283-6980
Practice Address - Fax:718-635-6750
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01847016Medicaid
NY01847016Medicaid
62J731Medicare ID - Type Unspecified