Provider Demographics
NPI:1790867059
Name:CHATHA, ARSHAD ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ARSHAD
Middle Name:ALI
Last Name:CHATHA
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 1:342 MERCER ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3118
Mailing Address - Country:US
Mailing Address - Phone:201-432-3775
Mailing Address - Fax:
Practice Address - Street 1:679 E 138TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3307
Practice Address - Country:US
Practice Address - Phone:718-585-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183114208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01199128Medicaid
NY01199128Medicaid