Provider Demographics
NPI:1871694661
Name:CHATTERJI, MANJU (MD)
Entity type:Individual
Prefix:DR
First Name:MANJU
Middle Name:
Last Name:CHATTERJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E 40TH ST APT 35G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1755
Mailing Address - Country:US
Mailing Address - Phone:815-353-0087
Mailing Address - Fax:
Practice Address - Street 1:350 E CONGRESS PKWY
Practice Address - Street 2:STE E
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6284
Practice Address - Country:US
Practice Address - Phone:815-477-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297201208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053398 1Medicaid
IL036053398 1Medicaid
IL214660 L62505Medicare ID - Type Unspecified