Healthcare Provider Details

I. General information

NPI: 1851167985
Provider Name (Legal Business Name): CHANDAN DEBNATH LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 7TH AVE FL 14
NEW YORK NY
10018-4603
US

IV. Provider business mailing address

160 MADISON AVE APT 9H
NEW YORK NY
10016-5412
US

V. Phone/Fax

Practice location:
  • Phone: 212-768-7979
  • Fax:
Mailing address:
  • Phone: 212-532-2326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007427-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: