Provider Demographics
NPI:1184805178
Name:DIABETES AND ENDOCRINE MEDICAL OFFICE PLLC
Entity type:Organization
Organization Name:DIABETES AND ENDOCRINE MEDICAL OFFICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDOCRINOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHITHRANJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-896-0008
Mailing Address - Street 1:6 LAFAYETTE CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3036
Mailing Address - Country:US
Mailing Address - Phone:845-896-0008
Mailing Address - Fax:845-896-2241
Practice Address - Street 1:6 LAFAYETTE CT
Practice Address - Street 2:SUITE 1
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3036
Practice Address - Country:US
Practice Address - Phone:845-896-0008
Practice Address - Fax:845-896-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-18
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199327207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEU421Medicare PIN