Provider Demographics
NPI:1639168933
Name:CHOUHDRY, IFTIKHAR-AHMAD SHAHID (MD)
Entity Type:Individual
Prefix:
First Name:IFTIKHAR-AHMAD
Middle Name:SHAHID
Last Name:CHOUHDRY
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 1:653 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12734-5142
Mailing Address - Country:US
Mailing Address - Phone:845-807-3635
Mailing Address - Fax:
Practice Address - Street 1:653 HARRIS RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:NY
Practice Address - Zip Code:12734-5142
Practice Address - Country:US
Practice Address - Phone:845-807-3635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165122207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30Q241Medicare ID - Type Unspecified
NYB19215Medicare UPIN