Provider Demographics
NPI:1467538835
Name:CHOUDHRY, RAFAT S (MD)
Entity Type:Individual
Prefix:
First Name:RAFAT
Middle Name:S
Last Name:CHOUDHRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 S NEW RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-3730
Mailing Address - Country:US
Mailing Address - Phone:609-652-4141
Mailing Address - Fax:609-652-9939
Practice Address - Street 1:1004 S NEW RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3730
Practice Address - Country:US
Practice Address - Phone:609-652-4141
Practice Address - Fax:609-652-9939
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA067637207R00000X
NJ25MA06763700208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG81287Medicare UPIN
NJ020185ZDGNMedicare PIN