Provider Demographics
NPI:1679929095
Name:CHASKES, MICHELLE ELANA (NP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ELANA
Last Name:CHASKES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ELANA
Other - Last Name:MAROWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:410 LAKEVILLE RD STE 305
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1123
Mailing Address - Country:US
Mailing Address - Phone:614-506-4744
Mailing Address - Fax:215-590-3053
Practice Address - Street 1:410 LAKEVILLE RD STE 305
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1123
Practice Address - Country:US
Practice Address - Phone:614-506-4744
Practice Address - Fax:215-590-3053
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017685363LP2300X
NYF383384-01363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1679929095Medicaid