Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 205494 | NY |
NPI | 1003997289 |
---|---|
Provider Name | Jayapratap Chenna |
First Address | Massapequa Park, NY 11762-0270 |
Second Address | New York, NY 10003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 24/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02058928 | (05) | NY |
H09134 | (02) |