Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 058919-1 | NY |
NPI | 1265772461 |
---|---|
Provider Name | Dr. Dave Chandra |
First Address | Armonk, NY 10504-1215 |
Second Address | New Hyde Park, NY 11040-1402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2013 |
Last Update Date | 06/03/2017 |