Provider Demographics
NPI:1811928138
Name:CHODOCK, ALLEN L (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:L
Last Name:CHODOCK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 RITCH AVE W # APTB304
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6956
Mailing Address - Country:US
Mailing Address - Phone:203-681-2610
Mailing Address - Fax:203-532-5712
Practice Address - Street 1:124 RITCH AVE W # APTB304
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6956
Practice Address - Country:US
Practice Address - Phone:203-681-2610
Practice Address - Fax:203-532-5712
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092732207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY909511Medicare ID - Type Unspecified
NYB20022Medicare UPIN