Provider Demographics
NPI:1306060827
Name:PHATAK, CHINTAMAN SADASHIVA (MD)
Entity type:Individual
Prefix:DR
First Name:CHINTAMAN
Middle Name:SADASHIVA
Last Name:PHATAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 66TH ROAD
Mailing Address - Street 2:#1B FOREST HILLS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1004
Mailing Address - Country:US
Mailing Address - Phone:718-896-6141
Mailing Address - Fax:516-621-0193
Practice Address - Street 1:10210 66TH ROAD
Practice Address - Street 2:#1B FOREST HILLS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11375-1004
Practice Address - Country:US
Practice Address - Phone:718-896-6141
Practice Address - Fax:516-621-0193
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115908207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
753755OtherAETNA INSURANCE
8571711011Medicare ID - Type UnspecifiedGHI MEDIA
753755OtherAETNA INSURANCE