Provider Demographics
NPI:1518139674
Name:CHADHA PHYSICIAN PC
Entity Type:Organization
Organization Name:CHADHA PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANG
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHADHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-544-6660
Mailing Address - Street 1:11203 QUEENS BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5550
Mailing Address - Country:US
Mailing Address - Phone:718-544-6660
Mailing Address - Fax:718-544-6670
Practice Address - Street 1:11203 QUEENS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5550
Practice Address - Country:US
Practice Address - Phone:718-544-6660
Practice Address - Fax:718-544-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149446261Q00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC06889Medicare UPIN