Provider Demographics
NPI:1063656882
Name:CHOWDHURY, FARHAD REZA (DO)
Entity Type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:REZA
Last Name:CHOWDHURY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5139
Mailing Address - Country:US
Mailing Address - Phone:914-984-2546
Mailing Address - Fax:
Practice Address - Street 1:3663 ROUTE 9 N STE 102
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3518
Practice Address - Country:US
Practice Address - Phone:732-679-7575
Practice Address - Fax:732-707-3850
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014059207YX0905X
NJ25MB08701400207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB08701400OtherLICENSE
NJP00938037OtherRAILROAD MEDICARE PIN
NJ187849NEWMedicare PIN