Healthcare Provider Details

I. General information

NPI: 1598964231
Provider Name (Legal Business Name): CHANDURPAL P GEHANI B.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 82ND ST # 1F
JACKSON HEIGHTS NY
11372-5159
US

IV. Provider business mailing address

3540 82ND ST # 1F
JACKSON HEIGHTS NY
11372-5159
US

V. Phone/Fax

Practice location:
  • Phone: 718-639-0192
  • Fax: 718-639-8122
Mailing address:
  • Phone: 718-639-0192
  • Fax: 718-639-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number033437
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: