MEDICARE: MR. SANTPAL SINGH CHAWLA FNP-C

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	363LF0000X	Family Nurse Practitioner	334159	NY

General Provider Information

NPI Number	:	1336184381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SANTPAL SINGH CHAWLA FNP-C

Provider Business Mailing Address
First Line	:	21 EDWARDS ST
Second Line	:	APT 1A
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1121
Country	:	US
Telephone Number	:	516-330-4215
Fax Number	:

Provider Business Practice Location Address
First Line	:	2343 NEW HYDE PARK RD
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1212
Country	:	US
Telephone Number	:	516-437-7236
Fax Number	:	516-437-7237

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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