Healthcare Provider Details

I. General information

NPI: 1154476257
Provider Name (Legal Business Name): VIJAYA L CHANDRAKANT MD P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 RICHMOND AVE # B
STATEN ISLAND NY
10314-1550
US

IV. Provider business mailing address

1468 RICHMOND AVE # B
STATEN ISLAND NY
10314-1550
US

V. Phone/Fax

Practice location:
  • Phone: 718-982-8922
  • Fax:
Mailing address:
  • Phone: 718-982-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number141332
License Number StateNY

VIII. Authorized Official

Name: DR. VIJAYA L CHANDRAKANT
Title or Position: PHYSICIAN
Credential: M.D
Phone: 718-982-8922