Provider Demographics
NPI:1720029770
Name:CHOUDRY, SAMINA (MD)
Entity Type:Individual
Prefix:
First Name:SAMINA
Middle Name:
Last Name:CHOUDRY
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 1:2834 RT. 17M
Mailing Address - Street 2:MID-HUDSON FORENSIC PSYCHIATRIC CENTER,
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958-0158
Mailing Address - Country:US
Mailing Address - Phone:845-283-3847
Mailing Address - Fax:
Practice Address - Street 1:2834 RT. 17M
Practice Address - Street 2:MID-HUDSON FORENSIC PSYCHIATRIC CENTER,
Practice Address - City:NEW HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:10958-0158
Practice Address - Country:US
Practice Address - Phone:845-283-3847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203922208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01689821Medicaid
NYSC03384N20OtherBCBS
G36038Medicare UPIN
SC016N0710Medicare PIN
NYSC03384N20OtherBCBS
P00108607Medicare PIN