Provider Demographics
NPI:1114955952
Name:CHAISE, JOEL MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MICHAEL
Last Name:CHAISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:2393 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1215
Practice Address - Country:US
Practice Address - Phone:914-219-0393
Practice Address - Fax:914-709-4097
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY148106207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02162054Medicaid
E42822Medicare UPIN
NY758V91Medicare ID - Type Unspecified