Provider Demographics
NPI:1598861767
Name:REZA CHOWDHURY MEDICAL PC
Entity Type:Organization
Organization Name:REZA CHOWDHURY MEDICAL PC
Other - Org Name:WESTCHESTER MEDICAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-851-6633
Mailing Address - Street 1:1957 WESTCHESTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4505
Mailing Address - Country:US
Mailing Address - Phone:347-851-6633
Mailing Address - Fax:347-851-6635
Practice Address - Street 1:1957 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4505
Practice Address - Country:US
Practice Address - Phone:347-851-6633
Practice Address - Fax:347-851-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241737261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02811347Medicaid
NYWNW031Medicare PIN
NY02811347Medicaid
NY016AUNW031Medicare PIN