Provider Demographics
NPI:1316357585
Name:ANJALI CHOUDHARY LLC
Entity Type:Organization
Organization Name:ANJALI CHOUDHARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJALI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-216-9040
Mailing Address - Street 1:550 NEWARK AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1326
Mailing Address - Country:US
Mailing Address - Phone:201-216-9040
Mailing Address - Fax:201-714-4828
Practice Address - Street 1:550 NEWARK AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1326
Practice Address - Country:US
Practice Address - Phone:201-216-9040
Practice Address - Fax:201-714-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06676900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7974400Medicaid