Provider Demographics
NPI:1891763801
Name:CHABRA, DAVE
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:
Last Name:CHABRA
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 1:124 08 A LIBERTY AVE
Mailing Address - Street 2:RICHMOND HILL
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:11419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:124 08 A LIBERTY AVE
Practice Address - Street 2:RICHMOND HILL
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:11419
Practice Address - Country:US
Practice Address - Phone:718-845-4466
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY003398173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00756423Medicaid
NY00756423Medicaid
T32135Medicare UPIN