Provider Demographics
NPI:1912088840
Name:CHISENA, ERNEST C (MD MS)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:C
Last Name:CHISENA
Suffix:
Gender:M
Credentials:MD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CENTERPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721
Mailing Address - Country:US
Mailing Address - Phone:631-261-0110
Mailing Address - Fax:631-261-7984
Practice Address - Street 1:101 CENTERPORT ROAD
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721
Practice Address - Country:US
Practice Address - Phone:631-261-0110
Practice Address - Fax:631-261-7984
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132029207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
45A561Medicare ID - Type Unspecified
B14872Medicare UPIN