Healthcare Provider Details

I. General information

NPI: 1518139674
Provider Name (Legal Business Name): CHADHA PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11203 QUEENS BLVD SUITE 201
FOREST HILLS NY
11375-5550
US

IV. Provider business mailing address

11203 QUEENS BLVD SUITE 201
FOREST HILLS NY
11375-5550
US

V. Phone/Fax

Practice location:
  • Phone: 718-544-6660
  • Fax: 718-544-6670
Mailing address:
  • Phone: 718-544-6660
  • Fax: 718-544-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number149446
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number149446
License Number StateNY

VIII. Authorized Official

Name: DR. JANG B CHADHA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-544-6660