MEDICARE: PREMETESH CHATTOO D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	2324841	NY

General Provider Information

NPI Number	:	1255395083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PREMETESH CHATTOO D.O.

Provider Business Mailing Address
First Line	:	122 FULTON ST
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10038-2717
Country	:	US
Telephone Number	:	212-361-9571
Fax Number	:	212-257-7087

Provider Business Practice Location Address
First Line	:	122 FULTON ST
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10038-2717
Country	:	US
Telephone Number	:	212-361-9571
Fax Number	:	212-257-7087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	01/30/2014

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