Provider Demographics
NPI:1851167985
Name:DEBNATH, CHANDAN (LAC)
Entity Type:Individual
Prefix:
First Name:CHANDAN
Middle Name:
Last Name:DEBNATH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:160 MADISON AVE APT 9H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5412
Mailing Address - Country:US
Mailing Address - Phone:212-532-2326
Mailing Address - Fax:
Practice Address - Street 1:512 7TH AVE FL 14
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4603
Practice Address - Country:US
Practice Address - Phone:212-768-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007427-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist