MEDICARE: DR. CHINTAMAN SADASHIVA PHATAK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	115908	NY
2	207R00000X	Internal Medicine Physician	115908	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	753755	OTHER		AETNA INSURANCE

General Provider Information

NPI Number	:	1306060827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHINTAMAN SADASHIVA PHATAK MD

Provider Business Mailing Address
First Line	:	10210 66TH ROAD
Second Line	:	#1B FOREST HILLS
City	:	NEW YORK
State	:	NY
Zip	:	11375-1004
Country	:	US
Telephone Number	:	718-896-6141
Fax Number	:	516-621-0193

Provider Business Practice Location Address
First Line	:	10210 66TH ROAD
Second Line	:	#1B FOREST HILLS
City	:	NEW YORK
State	:	NY
Zip	:	11375-1004
Country	:	US
Telephone Number	:	718-896-6141
Fax Number	:	516-621-0193

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	09/11/2025

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