Provider Demographics
NPI:1063851459
Name:CHOUDHURY, MUSHFIQUE (MD)
Entity Type:Individual
Prefix:
First Name:MUSHFIQUE
Middle Name:
Last Name:CHOUDHURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 NIXON CT
Mailing Address - Street 2:APT 3J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6528
Mailing Address - Country:US
Mailing Address - Phone:347-233-7047
Mailing Address - Fax:
Practice Address - Street 1:9 NIXON CT
Practice Address - Street 2:APT 3J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6528
Practice Address - Country:US
Practice Address - Phone:347-233-7047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY287381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program