Provider Demographics
NPI:1639149396
Name:CHAUDHARI-MODY, BINA K (MD)
Entity type:Individual
Prefix:MS
First Name:BINA
Middle Name:K
Last Name:CHAUDHARI-MODY
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 1:115 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1200
Mailing Address - Country:US
Mailing Address - Phone:516-365-9573
Mailing Address - Fax:
Practice Address - Street 1:4370 KISSENA BLVD
Practice Address - Street 2:1L
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3769
Practice Address - Country:US
Practice Address - Phone:718-539-6222
Practice Address - Fax:718-539-9490
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211043207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1937008Medicaid
NY1937008Medicaid