Provider Demographics
NPI:1255766192
Name:CHAKRABARTY, SANDEEP
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:CHAKRABARTY
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 1:11 HUDSON CT
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-5515
Mailing Address - Country:US
Mailing Address - Phone:215-910-9203
Mailing Address - Fax:
Practice Address - Street 1:11 HUDSON CT
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-5515
Practice Address - Country:US
Practice Address - Phone:215-910-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03161700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist