Provider Demographics
NPI:1528033487
Name:CHOUDHURY, ASWINI K (MD)
Entity Type:Individual
Prefix:
First Name:ASWINI
Middle Name:K
Last Name:CHOUDHURY
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 1:433 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:LAKE CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-6001
Mailing Address - Country:US
Mailing Address - Phone:845-225-5004
Mailing Address - Fax:845-225-1185
Practice Address - Street 1:433 ROUTE 52
Practice Address - Street 2:
Practice Address - City:LAKE CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-6001
Practice Address - Country:US
Practice Address - Phone:845-225-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00798581Medicaid
NYA99172Medicare UPIN
NY00798581Medicaid
P00108131Medicare PIN