Active NPI
Jason Avinash Chandebal, PA
- Physician Assistant
- Glen Oaks, NY
National Provider Identifier
1619573631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 026517
- Practice address
- 26701 Hillside Ave
Glen Oaks, NY 11004-1743 - Phone
- (718) 343-7790
- NPI assigned
- Dec 6, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 026517 | NY | Primary |
Addresses
Primary practice location
26701 Hillside Ave
Glen Oaks, NY 11004-1743
Mailing address
26701 Hillside Ave
Floral Park, NY 11004-1743
Phone (718) 343-7790
Other practice location 1
10437 Lefferts Blvd
South Richmond Hill, NY 11419-2709
Phone (718) 322-8494
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631836800000",
"number": "1619573631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26701 HILLSIDE AVE",
"city": "FLORAL PARK",
"state": "NY",
"postal_code": "110041743",
"telephone_number": "718-343-7790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26701 HILLSIDE AVE",
"city": "GLEN OAKS",
"state": "NY",
"postal_code": "110041743",
"telephone_number": "718-343-7790"
}
],
"practiceLocations": [
{
"address_1": "10437 Lefferts Blvd",
"address_purpose": "LOCATION",
"city": "South Richmond Hill",
"state": "NY",
"postal_code": "114192709",
"country_code": "US",
"telephone_number": "718-322-8494",
"fax_number": "718-322-8495",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHANDEBAL",
"first_name": "JASON",
"middle_name": "AVINASH",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-06",
"last_updated": "2021-09-17",
"certification_date": "2021-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "026517",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Oaks, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.