Provider Demographics
NPI:1922082791
Name:CHASE, HERBERT STANLEY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:STANLEY
Last Name:CHASE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:227 CENTRAL PARK W APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6058
Mailing Address - Country:US
Mailing Address - Phone:917-225-6937
Mailing Address - Fax:212-595-2371
Practice Address - Street 1:227 CENTRAL PARK W APT 3B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6058
Practice Address - Country:US
Practice Address - Phone:917-225-6937
Practice Address - Fax:212-595-2371
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124031207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001389586Medicaid
CT110008147Medicare ID - Type Unspecified
CT001389586Medicaid