1043452006 NPI number — MISS KAREN ANN CHANDA EARLY INTERVENTION

Table of content: MISS KAREN ANN CHANDA EARLY INTERVENTION (NPI 1043452006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043452006 NPI number — MISS KAREN ANN CHANDA EARLY INTERVENTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANDA
Provider First Name:
KAREN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
EARLY INTERVENTION
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043452006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 WALNUT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGS PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11754-2427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-979-3861
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 S BEECH ST # B102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORTEZ
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81321-3751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-946-1539
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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