Provider Demographics
NPI:1932737574
Name:CHOUDHARY, RAHEEJ
Entity Type:Individual
Prefix:
First Name:RAHEEJ
Middle Name:
Last Name:CHOUDHARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 NW 143RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2910
Mailing Address - Country:US
Mailing Address - Phone:954-304-6897
Mailing Address - Fax:
Practice Address - Street 1:115 BROADWAY RM 1300
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1600
Practice Address - Country:US
Practice Address - Phone:212-233-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9113108363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical