Provider Demographics
NPI:1346285079
Name:CHOUDHRY, HAMMAD S (MD)
Entity Type:Individual
Prefix:
First Name:HAMMAD
Middle Name:S
Last Name:CHOUDHRY
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 1:622 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3821
Mailing Address - Country:US
Mailing Address - Phone:201-436-2800
Mailing Address - Fax:201-436-1353
Practice Address - Street 1:622 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3821
Practice Address - Country:US
Practice Address - Phone:201-436-2800
Practice Address - Fax:201-436-1353
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07619400207RN0300X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0123293Medicaid
NJI59328Medicare UPIN
NJ103313TZJMedicare PIN