Healthcare Provider Details

I. General information

NPI: 1215231469
Provider Name (Legal Business Name): CHANCHAL K. SAHA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 OLD COUNTRY RD
PLAINVIEW NY
11803-4929
US

IV. Provider business mailing address

754 OLD COUNTRY RD
PLAINVIEW NY
11803-4929
US

V. Phone/Fax

Practice location:
  • Phone: 516-931-0182
  • Fax: 516-681-2312
Mailing address:
  • Phone: 516-931-0182
  • Fax: 516-681-2312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number116823
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CHANCHAL KUMAR SAHA
Title or Position: PRES
Credential: MD
Phone: 516-931-0182