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General NPI Number Information
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NPI Number | 1790974269
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Entity Type | Organization
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Legal Business Name | KOMAL CHANDAN PHYSICIAN PLLC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 4600 MILITARY RD SUITE A
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City | NIAGARA FALLS
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State | NY
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Zip | 14305-1338
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Country | US
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Telephone | 716-298-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 MILITARY RD SUITE A
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City | NIAGARA FALLS
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State | NY
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Zip | 14305-1338
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Country | US
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Telephone | 716-298-4050
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KOMAL CHANDAN
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Credential | M.D
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Telephone | 716-298-4050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 189392
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License Number State | NY
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