Provider Demographics
NPI:1659366946
Name:CHANDOK, BOBBY (MD)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:CHANDOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WALT WHITMAN RD STE 100B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3631
Mailing Address - Country:US
Mailing Address - Phone:631-425-1000
Mailing Address - Fax:631-425-1008
Practice Address - Street 1:33 WALT WHITMAN RD STE 100B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3631
Practice Address - Country:US
Practice Address - Phone:631-425-1000
Practice Address - Fax:631-425-1008
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232641207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
264AQ1OtherEMPIRE BC-BS
NWH-TAX IDOtherBEECH STREET
2589701OtherGHI-PPO
3C5202OtherHEALTHNET -GRP #
P3506922OtherOXFORD HEALTH PLAN
3761366OtherAETNA-HMO
060206000159OtherFIDELISCARE OF NY
000000087399OtherGHI-HMO
7905618OtherAETNA - PPO
10110711-UI04OtherCDPHP PROVIDER # & GRP #
388168OtherMVP HEALTHPLAN
NY246AQEU121Medicare PIN
P3506922OtherOXFORD HEALTH PLAN
NYP00214248Medicare PIN
NWH-TAX IDOtherBEECH STREET