Healthcare Provider Details

I. General information

NPI: 1326146721
Provider Name (Legal Business Name): MANOJ CHHABRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 7TH AVE STE 3B
BROOKLYN NY
11215-3693
US

IV. Provider business mailing address

263 7TH AVE
BROOKLYN NY
11215-7247
US

V. Phone/Fax

Practice location:
  • Phone: 187-780-3066
  • Fax: 718-246-8541
Mailing address:
  • Phone: 718-780-5260
  • Fax: 718-780-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number208547
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number208547
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: