Provider Demographics
NPI:1639277403
Name:CHAZKEL, RICHARD ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:CHAZKEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:40 HURLEY AVENUE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3738
Mailing Address - Country:US
Mailing Address - Phone:845-331-1811
Mailing Address - Fax:845-331-3692
Practice Address - Street 1:40 HURLEY AVENUE
Practice Address - Street 2:SUITE 9
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3738
Practice Address - Country:US
Practice Address - Phone:845-331-1811
Practice Address - Fax:845-331-3692
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1310291208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00775475Medicaid
NY00775475Medicaid
A64439Medicare UPIN