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General NPI Number Information
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NPI Number | 1073992152
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Entity Type | Individual
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Provider Name | JOEL MYLADOOR CHANDY D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 260 PATCHOGUE YAPHANK RD
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4886
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Country | US
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Telephone | 631-289-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 8 HARTON CT
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-5923
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Country | US
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Telephone | 516-474-8572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 308161
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License Number State | NY
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