Provider Demographics
NPI:1982602595
Name:CHANDER, SATISH
Entity type:Individual
Prefix:
First Name:SATISH
Middle Name:
Last Name:CHANDER
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-0606
Mailing Address - Country:US
Mailing Address - Phone:845-635-8755
Mailing Address - Fax:845-635-1355
Practice Address - Street 1:1339 ROUTE 44
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7825
Practice Address - Country:US
Practice Address - Phone:845-635-8755
Practice Address - Fax:845-635-1355
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00548623Medicaid
C06780Medicare UPIN
21A031Medicare ID - Type Unspecified