Healthcare Provider Details

I. General information

NPI: 1720146434
Provider Name (Legal Business Name): SUNEETHA CHOWDARY PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1782 DUTCH BROADWAY
ELMONT NY
11003-5006
US

IV. Provider business mailing address

24156 OAK PARK DR
LITTLE NECK NY
11362-2620
US

V. Phone/Fax

Practice location:
  • Phone: 516-643-2199
  • Fax:
Mailing address:
  • Phone: 718-229-1554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number197956
License Number StateNY

VIII. Authorized Official

Name: SUNEETHA CHOWDARY
Title or Position: DIRECTOR OFFICER
Credential:
Phone: 516-643-2199