Provider Demographics
NPI:1316199284
Name:CHOUHDRY AND BUTLER PHYSICIAN SERVICES, PLLC
Entity Type:Organization
Organization Name:CHOUHDRY AND BUTLER PHYSICIAN SERVICES, PLLC
Other - Org Name:NEW VISION HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:UMAR
Authorized Official - Middle Name:IFTIKHAR
Authorized Official - Last Name:CHOUHDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-751-1465
Mailing Address - Street 1:184 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-1820
Mailing Address - Country:US
Mailing Address - Phone:917-751-1465
Mailing Address - Fax:
Practice Address - Street 1:184 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1820
Practice Address - Country:US
Practice Address - Phone:917-751-1465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236869-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty