Healthcare Provider Details

I. General information

NPI: 1811171523
Provider Name (Legal Business Name): DEVENDER NATH CHHABRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 BRITTON AVE 2C
ELMHURST NY
11373-2470
US

IV. Provider business mailing address

8201 BRITTON AVE 2C
ELMHURST NY
11373-2470
US

V. Phone/Fax

Practice location:
  • Phone: 718-426-4353
  • Fax:
Mailing address:
  • Phone: 718-426-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number034930
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: