Provider Demographics
NPI:1881606523
Name:YOGANATHAN, CHANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:
Last Name:YOGANATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 FULTON ST
Mailing Address - Street 2:ROOM 600
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:212-571-0520
Mailing Address - Fax:212-732-7903
Practice Address - Street 1:139 FULTON ST
Practice Address - Street 2:ROOM 600
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038
Practice Address - Country:US
Practice Address - Phone:212-571-0520
Practice Address - Fax:212-732-7903
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1431192081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00849409Medicaid
B18656Medicare UPIN
NY69A671Medicare ID - Type Unspecified