Provider Demographics
NPI:1558412510
Name:CHAUDHRI, AFTAB A (MD)
Entity Type:Individual
Prefix:
First Name:AFTAB
Middle Name:A
Last Name:CHAUDHRI
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 1:965 FENWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010
Mailing Address - Country:US
Mailing Address - Phone:516-352-1124
Mailing Address - Fax:516-352-0518
Practice Address - Street 1:965 FENWORTH BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010
Practice Address - Country:US
Practice Address - Phone:516-352-1124
Practice Address - Fax:516-352-0518
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00783293Medicaid
NY00783293Medicaid
AC094A8510Medicare ID - Type Unspecified