Individual
MR. CHASE MONTGOMERY MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1623 FLATBUSH AVE STE 4, BROOKLYN, NY 11210-3264
(718) 377-5755
Mailing address
517 W 161ST ST APT 65, NEW YORK, NY 10032-6115
(347) 894-7025
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
NYCPS-P-200062
NY
Other
Enumeration date
01/19/2024
Last updated
01/19/2024
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