Provider Demographics
NPI:1003168451
Name:JAY S. CHANDAR, MD, PA
Entity Type:Organization
Organization Name:JAY S. CHANDAR, MD, PA
Other - Org Name:CHILDRENS CARDIAC CENTER, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:954-894-4115
Mailing Address - Street 1:3850 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6700
Mailing Address - Country:US
Mailing Address - Phone:954-894-4115
Mailing Address - Fax:954-894-2116
Practice Address - Street 1:3850 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6700
Practice Address - Country:US
Practice Address - Phone:954-894-4115
Practice Address - Fax:954-894-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME503752080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046625502Medicaid
FL046625502Medicaid