Gerard George Chisnall, R.P.A.

Key facts

NPI

1124136569

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

License

23-00763 (NY)

Practice address

151 Knollcroft Rd
Lyons, NJ 07939-5001

Phone

(908) 647-0180

Fax

(908) 604-5850

NPI assigned

Aug 27, 2006

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124136569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4864 CONCORD DR",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180458116",
            "telephone_number": "610-751-8817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 KNOLLCROFT RD",
            "city": "LYONS",
            "state": "NJ",
            "postal_code": "079395001",
            "telephone_number": "908-647-0180",
            "fax_number": "908-604-5850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHISNALL",
        "first_name": "GERARD",
        "middle_name": "GEORGE",
        "name_prefix": "Mr.",
        "credential": "R.P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "23-00763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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