Healthcare Provider Details

I. General information

NPI: 1871623728
Provider Name (Legal Business Name): ANN E CHEMMANOOR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 AVENUE OF THE AMERICAS FL 8
NEW YORK NY
10105-0018
US

IV. Provider business mailing address

1345 AVENUE OF THE AMERICAS FL 8
NEW YORK NY
10105-0018
US

V. Phone/Fax

Practice location:
  • Phone: 646-362-5683
  • Fax:
Mailing address:
  • Phone: 646-362-5683
  • Fax: 646-846-3283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP01021700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009790
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: