Healthcare Provider Details

I. General information

NPI: 1386878981
Provider Name (Legal Business Name): VICTOR C CHANDUVI ST/SA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 JAN CT
ELMWOOD PARK NJ
07407-2724
US

IV. Provider business mailing address

9 JAN CT
ELMWOOD PARK NJ
07407-2724
US

V. Phone/Fax

Practice location:
  • Phone: 973-405-1745
  • Fax:
Mailing address:
  • Phone: 973-405-1745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: