Provider Demographics
NPI:1659589273
Name:INTERNAL MEDICINE AND GERIATRICS ASSOCIATES PLLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE AND GERIATRICS ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAHANZEB
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-588-4888
Mailing Address - Street 1:233 UNION AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1821
Mailing Address - Country:US
Mailing Address - Phone:631-588-4888
Mailing Address - Fax:631-588-4840
Practice Address - Street 1:233 UNION AVE STE 206
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1821
Practice Address - Country:US
Practice Address - Phone:631-588-4888
Practice Address - Fax:631-588-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WET241Medicare ID - Type UnspecifiedEMPIRE
06760Medicare ID - Type UnspecifiedGHI