Healthcare Provider Details

I. General information

NPI: 1184811135
Provider Name (Legal Business Name): SANDEEP S KOCHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7785 N STATE ST
LOWVILLE NY
13367-1229
US

IV. Provider business mailing address

8 PETER COOPER RD APT 8F
NEW YORK NY
10010-6711
US

V. Phone/Fax

Practice location:
  • Phone: 347-742-2982
  • Fax:
Mailing address:
  • Phone: 702-453-3799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number002834-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: