Provider Demographics
NPI:1972595163
Name:CHANDER, HARISH (MD)
Entity type:Individual
Prefix:
First Name:HARISH
Middle Name:
Last Name:CHANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 RIVER AVE STE 140
Mailing Address - Street 2:SHORE MEDICAL SPECIALISTS
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4743
Mailing Address - Country:US
Mailing Address - Phone:732-363-7200
Mailing Address - Fax:732-363-8183
Practice Address - Street 1:500 RIVER AVE STE 140
Practice Address - Street 2:SHORE MEDICAL SPECIALISTS
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4743
Practice Address - Country:US
Practice Address - Phone:732-363-7200
Practice Address - Fax:732-363-8183
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ29717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0612901Medicaid
NJ0612901Medicaid
NJC53099Medicare UPIN