Basic Information
| Provider Information | |||||||||
| NPI: | 1881073740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHYKYDA | ||||||||
| FirstName: | HALYNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 KENNEDY PL | ||||||||
| Address2: | |||||||||
| City: | VERNON HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600611037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2244029100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 N COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117772119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314731320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2015 | ||||||||
| LastUpdateDate: | 09/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 294692 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 251300000X | N | Agencies | Local Education Agency (LEA) |
No ID Information.