Provider Demographics
NPI:1548377096
Name:CHIDECKEL, NORMAN JAY (MD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:JAY
Last Name:CHIDECKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30809
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-0809
Mailing Address - Country:US
Mailing Address - Phone:212-473-1877
Mailing Address - Fax:212-473-4733
Practice Address - Street 1:161 MADISON AVE
Practice Address - Street 2:RM 9SE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5445
Practice Address - Country:US
Practice Address - Phone:212-473-1877
Practice Address - Fax:212-473-4733
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06721400208600000X
NY145388208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2599594OtherAETNA
051217200593OtherCENTERCARE
1453881320OtherHEALTH FIRST
NYNS485OtherOXFORD
0008647OtherGHI
NY00907924Medicaid
02710330108OtherCIGNA
27247POtherHID
3C1680OtherHEALTHNET
352156OtherUNITED HEALTH
2599594OtherAETNA
ON6001Medicare ID - Type Unspecified