Healthcare Provider Details

I. General information

NPI: 1366826489
Provider Name (Legal Business Name): ANOO CHANDROTH RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W KINGSBRIDGE RD
BRONX NY
10468-3904
US

IV. Provider business mailing address

7 VIVIAN AVE
EMERSON NJ
07630-1123
US

V. Phone/Fax

Practice location:
  • Phone: 718-548-9000
  • Fax:
Mailing address:
  • Phone: 201-483-6082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number43ZA00613400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number008738-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: