Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 119056 | NY |
NPI | 1841366127 |
---|---|
Provider Name | Manju Chandra |
First Address | Mineola, NY 11501-2529 |
Second Address | Mineola, NY 11501-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 03/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00630828 | (05) | NY |
C08155 | (02) | NY |