Provider Demographics
NPI:1568742575
Name:CHETAN MALHOTRA, MD P.C.
Entity Type:Organization
Organization Name:CHETAN MALHOTRA, MD P.C.
Other - Org Name:PROGRESSIVE MEDICAL GROUP OF NEW YORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-541-1900
Mailing Address - Street 1:575 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5019
Mailing Address - Country:US
Mailing Address - Phone:516-541-1900
Mailing Address - Fax:516-612-8834
Practice Address - Street 1:575 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5019
Practice Address - Country:US
Practice Address - Phone:516-541-1900
Practice Address - Fax:516-612-8834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty