Provider Demographics
NPI:1720146434
Name:SUNEETHA CHOWDARY PHYSICIAN PC
Entity Type:Organization
Organization Name:SUNEETHA CHOWDARY PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUNEETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOWDARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-643-2199
Mailing Address - Street 1:24156 OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2620
Mailing Address - Country:US
Mailing Address - Phone:718-229-1554
Mailing Address - Fax:
Practice Address - Street 1:1782 DUTCH BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-5006
Practice Address - Country:US
Practice Address - Phone:516-643-2199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197956173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG46675Medicare UPIN
NYWEW291Medicare PIN
NY21N172Medicare PIN