Provider Demographics
NPI:1659655991
Name:CHAUDHARY, ALIYA ASLAM (MD)
Entity Type:Individual
Prefix:
First Name:ALIYA
Middle Name:ASLAM
Last Name:CHAUDHARY
Suffix:
Gender:F
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:MICKLETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08056-0069
Mailing Address - Country:US
Mailing Address - Phone:856-430-8072
Mailing Address - Fax:856-848-8038
Practice Address - Street 1:1132 COOPER ST
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3014
Practice Address - Country:US
Practice Address - Phone:856-848-8060
Practice Address - Fax:856-848-8038
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441124174400000X
NJ25MA09435800208000000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No174400000XOther Service ProvidersSpecialist
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty