Provider Demographics
NPI:1093758773
Name:CHATHAM MEDICAL PC
Entity Type:Organization
Organization Name:CHATHAM MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GARMAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-766-2800
Mailing Address - Street 1:PO BOX 130227
Mailing Address - Street 2:CO GARMAN T HO MD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-0986
Mailing Address - Country:US
Mailing Address - Phone:212-766-2800
Mailing Address - Fax:212-766-2066
Practice Address - Street 1:139 CENTRE ST
Practice Address - Street 2:SUITE 607
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4556
Practice Address - Country:US
Practice Address - Phone:212-766-2800
Practice Address - Fax:212-766-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204645207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01862913Medicaid
NYWEW531Medicare ID - Type Unspecified
G67045Medicare UPIN