Healthcare Provider Details

I. General information

NPI: 1861659393
Provider Name (Legal Business Name): SUJANA CHANDRASEKHAR, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 E 69TH ST
NEW YORK NY
10021-5706
US

IV. Provider business mailing address

364 E 69TH ST
NEW YORK NY
10021-5706
US

V. Phone/Fax

Practice location:
  • Phone: 212-249-3232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number179192-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. SUJANA S. CHANDRASEKHAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-249-3232