Provider Demographics
NPI:1952334534
Name:CHANDRAMOHAN, KUNJURAMAN (MD)
Entity Type:Individual
Prefix:MR
First Name:KUNJURAMAN
Middle Name:
Last Name:CHANDRAMOHAN
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 1:1999 DUTCH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4244
Mailing Address - Country:US
Mailing Address - Phone:516-285-0707
Mailing Address - Fax:516-285-1397
Practice Address - Street 1:1999 DUTCH BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4244
Practice Address - Country:US
Practice Address - Phone:516-285-0707
Practice Address - Fax:516-285-1397
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140727207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00669934Medicaid
204SN1Medicare Oscar/Certification
NYB17151Medicare UPIN
B17151Medicare UPIN
NY62A951Medicare ID - Type Unspecified