Provider Demographics
NPI:1912006883
Name:CHAUDHARY, FARZANA (MD)
Entity Type:Individual
Prefix:
First Name:FARZANA
Middle Name:
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 1:61 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-1400
Mailing Address - Country:US
Mailing Address - Phone:315-298-6569
Mailing Address - Fax:315-298-7831
Practice Address - Street 1:510 S 4TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2904
Practice Address - Country:US
Practice Address - Phone:315-598-4790
Practice Address - Fax:315-593-6195
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182089208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02997217Medicaid
NY00355266Medicaid
D89355Medicare UPIN
NY00355266Medicaid