Provider Demographics
NPI:1396734794
Name:CHMIELEWSKI, RICHARD (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:CHMIELEWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OXFORD XING STE 1
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-3200
Mailing Address - Country:US
Mailing Address - Phone:315-507-4751
Mailing Address - Fax:315-765-6056
Practice Address - Street 1:1 OXFORD XING STE 1
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-3200
Practice Address - Country:US
Practice Address - Phone:315-507-4751
Practice Address - Fax:315-765-6056
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137275-1207P00000X
NYNY137275207QA0401X, 208D00000X
NY137275204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE59169Medicare UPIN
NYBB9110Medicare ID - Type UnspecifiedMEDICARE
NY01295716Medicaid