Provider Demographics
NPI:1710051636
Name:CHATTERJEE, PARTHA
Entity Type:Individual
Prefix:
First Name:PARTHA
Middle Name:
Last Name:CHATTERJEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MARCUS DR
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4230
Mailing Address - Country:US
Mailing Address - Phone:631-391-7889
Mailing Address - Fax:631-454-4163
Practice Address - Street 1:8906 135TH ST
Practice Address - Street 2:SUITE 5S
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418-2828
Practice Address - Country:US
Practice Address - Phone:718-206-6742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233706208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02588085Medicaid
NYG99592Medicare UPIN
NY564351Medicare ID - Type Unspecified