Provider Demographics
NPI:1720002595
Name:SAHA, CHANCHAL K (M D)
Entity Type:Individual
Prefix:DR
First Name:CHANCHAL
Middle Name:K
Last Name:SAHA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4929
Mailing Address - Country:US
Mailing Address - Phone:516-931-0182
Mailing Address - Fax:516-681-2312
Practice Address - Street 1:754 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4929
Practice Address - Country:US
Practice Address - Phone:516-931-0182
Practice Address - Fax:516-681-2312
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB13160Medicare UPIN
NY330521Medicare ID - Type Unspecified