Provider Demographics
NPI:1497016869
Name:SUBRAMANIAN, CHAMUNDESWARI
Entity Type:Individual
Prefix:
First Name:CHAMUNDESWARI
Middle Name:
Last Name:SUBRAMANIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 HUGUENOT ST
Mailing Address - Street 2:APARTMENT 217
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6387
Mailing Address - Country:US
Mailing Address - Phone:860-329-1278
Mailing Address - Fax:
Practice Address - Street 1:16 GUION PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5502
Practice Address - Country:US
Practice Address - Phone:914-365-4300
Practice Address - Fax:914-633-4553
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine