Provider Demographics
NPI:1760821151
Name:CHOUDHRY, KASHIF M (PA)
Entity Type:Individual
Prefix:MR
First Name:KASHIF
Middle Name:M
Last Name:CHOUDHRY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10376 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1732
Mailing Address - Country:US
Mailing Address - Phone:718-637-9166
Mailing Address - Fax:
Practice Address - Street 1:10376 103RD ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1732
Practice Address - Country:US
Practice Address - Phone:718-637-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant