Provider Demographics
NPI:1407108780
Name:FAYEZ FADI CHAHFE
Entity Type:Organization
Organization Name:FAYEZ FADI CHAHFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAYEZ
Authorized Official - Middle Name:F
Authorized Official - Last Name:CHAHFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-792-4623
Mailing Address - Street 1:2206 GENESEE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5829
Mailing Address - Country:US
Mailing Address - Phone:315-792-4623
Mailing Address - Fax:315-792-6901
Practice Address - Street 1:2206 GENESEE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5829
Practice Address - Country:US
Practice Address - Phone:315-792-4623
Practice Address - Fax:315-792-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197706-1207Y00000X
NY001910-57231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01534303Medicaid
NY01534303Medicaid