Provider Demographics
NPI:1093077844
Name:ADOLF, CHANI (MS)
Entity Type:Individual
Prefix:MRS
First Name:CHANI
Middle Name:
Last Name:ADOLF
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 43RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1033
Mailing Address - Country:US
Mailing Address - Phone:718-633-9554
Mailing Address - Fax:718-972-5507
Practice Address - Street 1:1619 43RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1033
Practice Address - Country:US
Practice Address - Phone:718-633-9554
Practice Address - Fax:718-972-5507
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY870410981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist