Healthcare Provider Details

I. General information

NPI: 1629769062
Provider Name (Legal Business Name): CHAYA GEWANTER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 WALLABOUT ST
BROOKLYN NY
11249-7830
US

IV. Provider business mailing address

14709 76TH AVE APT 2F
FLUSHING NY
11367-3149
US

V. Phone/Fax

Practice location:
  • Phone: 718-260-4600
  • Fax: 718-797-9075
Mailing address:
  • Phone: 561-866-4359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number029903
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: