Provider Demographics
NPI:1538330808
Name:CHICHESTER, JEFFREY D (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:CHICHESTER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6003
Mailing Address - Country:US
Mailing Address - Phone:631-376-0318
Mailing Address - Fax:631-376-0319
Practice Address - Street 1:576 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6003
Practice Address - Country:US
Practice Address - Phone:631-376-0318
Practice Address - Fax:631-376-0319
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ10T1Q5VS1Medicare PIN