Healthcare Provider Details

I. General information

NPI: 1750016267
Provider Name (Legal Business Name): CHANDRA BHUSHAN RAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WATERS PL
BRONX NY
10461-2723
US

IV. Provider business mailing address

1500 WATERS PL
BRONX NY
10461-2723
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-0600
  • Fax: 718-862-4879
Mailing address:
  • Phone: 718-931-0600
  • Fax: 718-862-4858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number343996
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: