Provider Demographics
NPI:1811685589
Name:CHUADHRY, IKHTESHAM (DO)
Entity type:Individual
Prefix:
First Name:IKHTESHAM
Middle Name:
Last Name:CHUADHRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MCCORMICK AVE S
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-7012
Mailing Address - Country:US
Mailing Address - Phone:732-407-0032
Mailing Address - Fax:
Practice Address - Street 1:18 E LAUREL RD OFC
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1327
Practice Address - Country:US
Practice Address - Phone:609-206-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program