Provider Demographics
NPI:1861659393
Name:SUJANA CHANDRASEKHAR, MD
Entity Type:Organization
Organization Name:SUJANA CHANDRASEKHAR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUJANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANDRASEKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-249-3232
Mailing Address - Street 1:364 E 69TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:364 E 69TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5706
Practice Address - Country:US
Practice Address - Phone:212-249-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179192-1207YX0901X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY120315OtherOPERATING ENGINEERS LOCAL 825
NY1180621OtherAETNA
NY8M0242OtherEMPIRE BLUE CROSS BLUE SHIELD
NYP877572OtherOXFORD
NY=========Other1199 NATIONAL BENEFIT FUND
NYP877572OtherOXFORD