Provider Demographics
NPI:1811171523
Name:CHHABRA, DEVENDER NATH (MD)
Entity type:Individual
Prefix:DR
First Name:DEVENDER
Middle Name:NATH
Last Name:CHHABRA
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 1:8201 BRITTON AVE
Mailing Address - Street 2:2C
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2470
Mailing Address - Country:US
Mailing Address - Phone:718-426-4353
Mailing Address - Fax:
Practice Address - Street 1:8201 BRITTON AVE
Practice Address - Street 2:2C
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-2470
Practice Address - Country:US
Practice Address - Phone:718-426-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0349301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDC0D7F261OtherMEDICARE MCR
NY00480373Medicaid