Provider Demographics
NPI:1871548776
Name:CHAWLA, OPKAR S (MD)
Entity type:Individual
Prefix:
First Name:OPKAR
Middle Name:S
Last Name:CHAWLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:500 COMMACK RD UNIT 206
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5022
Mailing Address - Country:US
Mailing Address - Phone:631-675-2125
Mailing Address - Fax:631-675-2628
Practice Address - Street 1:23 HOWELL AVENUE
Practice Address - Street 2:STONY BROOK EXTENDED CARE
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2133
Practice Address - Country:US
Practice Address - Phone:631-542-0550
Practice Address - Fax:631-542-7473
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY183894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE62570Medicare UPIN
NY88F101Medicare ID - Type Unspecified