Healthcare Provider Details

I. General information

NPI: 1073992152
Provider Name (Legal Business Name): JOEL MYLADOOR CHANDY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 PATCHOGUE YAPHANK RD
EAST PATCHOGUE NY
11772-4886
US

IV. Provider business mailing address

8 HARTON CT
EAST NORTHPORT NY
11731-5923
US

V. Phone/Fax

Practice location:
  • Phone: 631-289-0300
  • Fax:
Mailing address:
  • Phone: 516-474-8572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number308161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: