Provider Demographics
NPI:1619535713
Name:CHISHTI, MOHAMMED KUDDUS
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:KUDDUS
Last Name:CHISHTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10659 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1541
Mailing Address - Country:US
Mailing Address - Phone:718-974-9998
Mailing Address - Fax:
Practice Address - Street 1:10659 95TH ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1541
Practice Address - Country:US
Practice Address - Phone:718-974-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty