Healthcare Provider Details

I. General information

NPI: 1366604605
Provider Name (Legal Business Name): SAMIA RIAZ CHAUDRY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 04 GOLDBLATT TERRACE
FAIR LAWN NJ
07410-5911
US

IV. Provider business mailing address

41-04 GOLDBLATT TER
FAIR LAWN NJ
07410-5911
US

V. Phone/Fax

Practice location:
  • Phone: 201-797-7129
  • Fax: 201-703-6982
Mailing address:
  • Phone: 201-797-7129
  • Fax: 201-703-6982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB08847900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: