Provider Demographics
NPI:1639878507
Name:CHANCY, JONATHAN (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:CHANCY
Suffix:
Gender:M
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 OCEAN AVE APT 6C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1442
Mailing Address - Country:US
Mailing Address - Phone:718-288-5064
Mailing Address - Fax:
Practice Address - Street 1:15 CANAL RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-2741
Practice Address - Country:US
Practice Address - Phone:646-512-8704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025764124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist