Provider Demographics
NPI:1285921726
Name:CHANDRA MOHAN, VINOTH KAILASH
Entity type:Individual
Prefix:MR
First Name:VINOTH KAILASH
Middle Name:
Last Name:CHANDRA MOHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5436
Mailing Address - Country:US
Mailing Address - Phone:516-442-1055
Mailing Address - Fax:516-442-1056
Practice Address - Street 1:509 MERRICK RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5436
Practice Address - Country:US
Practice Address - Phone:516-442-1055
Practice Address - Fax:516-442-1056
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist