Provider Demographics
NPI:1669643474
Name:CHAINANI, ASHOK N (BDS)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:N
Last Name:CHAINANI
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2042
Mailing Address - Country:US
Mailing Address - Phone:718-720-0066
Mailing Address - Fax:718-720-0002
Practice Address - Street 1:253 BROAD ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2042
Practice Address - Country:US
Practice Address - Phone:718-720-0066
Practice Address - Fax:718-720-0002
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0367271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00842824Medicaid