Provider Demographics
NPI:1851857957
Name:CHUDASMA, AMAR (MD)
Entity Type:Individual
Prefix:
First Name:AMAR
Middle Name:
Last Name:CHUDASMA
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 1:3543 63RD ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2137
Mailing Address - Country:US
Mailing Address - Phone:718-458-1817
Mailing Address - Fax:
Practice Address - Street 1:309 RUTLEDGE ST STE 2B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7512
Practice Address - Country:US
Practice Address - Phone:845-738-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP14821208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice