Provider Demographics
NPI:1013528595
Name:CHAUDRY, MOHAMMAD ABRAHAM (NP)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ABRAHAM
Last Name:CHAUDRY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ARCADIA LN
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4440
Mailing Address - Country:US
Mailing Address - Phone:646-821-7979
Mailing Address - Fax:
Practice Address - Street 1:54 ARCADIA LN
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4440
Practice Address - Country:US
Practice Address - Phone:646-821-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309744363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health