Basic Information
| Provider Information | |||||||||
| NPI: | 1942276589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAO | ||||||||
| FirstName: | KENNETH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 880 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117582351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165410300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1530 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | EAST MEADOW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115542265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165203053 | ||||||||
| FaxNumber: | 9294559653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 227038 | NY | N | Other Service Providers | Specialist | 2084N0400X | 227038 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.