Healthcare Provider Details

I. General information

NPI: 1700553898
Provider Name (Legal Business Name): CHANDLER HUTCHINSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST STE VC260
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST STE VC260
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5069
  • Fax:
Mailing address:
  • Phone: 212-305-5069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number030450
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: