Provider Demographics
NPI:1609993823
Name:CHOTU CORPORATION
Entity Type:Organization
Organization Name:CHOTU CORPORATION
Other - Org Name:CHOTU PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIWAN
Authorized Official - Middle Name:CHAND
Authorized Official - Last Name:GULATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-296-1023
Mailing Address - Street 1:7417 101ST AVE
Mailing Address - Street 2:CHOTU PHARMACY
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416
Mailing Address - Country:US
Mailing Address - Phone:718-296-1023
Mailing Address - Fax:718-296-1023
Practice Address - Street 1:7417 101ST AVE
Practice Address - Street 2:CHOTU PHARMACY
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416
Practice Address - Country:US
Practice Address - Phone:718-296-1023
Practice Address - Fax:718-296-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020850333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01230804Medicaid