Provider Demographics
NPI:1215554548
Name:CHAIKEN, JILLIAN K
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:K
Last Name:CHAIKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 5TH AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1215
Mailing Address - Country:US
Mailing Address - Phone:215-901-0563
Mailing Address - Fax:
Practice Address - Street 1:235 5TH AVE APT 2L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1215
Practice Address - Country:US
Practice Address - Phone:215-901-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist