Provider Demographics
NPI:1023126729
Name:CHILES, BENNIE W III (MD)
Entity type:Individual
Prefix:
First Name:BENNIE
Middle Name:W
Last Name:CHILES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-0957
Mailing Address - Country:US
Mailing Address - Phone:914-332-0396
Mailing Address - Fax:914-468-8895
Practice Address - Street 1:280 N CENTRAL AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1832
Practice Address - Country:US
Practice Address - Phone:914-332-0396
Practice Address - Fax:914-468-8895
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193451207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG73355Medicare UPIN
NY90E011Medicare PIN