Provider Demographics
NPI:1255533600
Name:NEW YORK MEDICAL BEHAVIORAL HEALTH, PC
Entity type:Organization
Organization Name:NEW YORK MEDICAL BEHAVIORAL HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHIPAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAUDHRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-442-6960
Mailing Address - Street 1:890 WESTFALL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2610
Mailing Address - Country:US
Mailing Address - Phone:585-442-6960
Mailing Address - Fax:585-442-3589
Practice Address - Street 1:890 WESTFALL RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2610
Practice Address - Country:US
Practice Address - Phone:585-442-6960
Practice Address - Fax:585-442-3589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0080OtherMEDICARE PTAN