Provider Demographics
NPI:1508933094
Name:CHAUDHARY, IMTIAZ A (MD)
Entity Type:Individual
Prefix:DR
First Name:IMTIAZ
Middle Name:A
Last Name:CHAUDHARY
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 1:736 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3273
Mailing Address - Country:US
Mailing Address - Phone:732-738-7474
Mailing Address - Fax:732-738-9332
Practice Address - Street 1:736 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3273
Practice Address - Country:US
Practice Address - Phone:732-738-7474
Practice Address - Fax:732-738-9332
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34378207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C54124Medicare UPIN