Healthcare Provider Details

I. General information

NPI: 1679532428
Provider Name (Legal Business Name): DAVE CHABRA D.P.M
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 08 A LIBERTY AVE
RICHMOND HILL NY
11419
US

IV. Provider business mailing address

124 08 A LIBERTY AVE
RICHMOND HILL NY
11419
US

V. Phone/Fax

Practice location:
  • Phone: 718-845-4466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number003398
License Number StateNY

VIII. Authorized Official

Name: DAVE CHABRA
Title or Position: SOLE PROPRIETER
Credential:
Phone: 718-845-4466