Healthcare Provider Details

I. General information

NPI: 1922380856
Provider Name (Legal Business Name): SAMIA R. CHAUDRY DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41-04 GOLDBLATT TER
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: SAMIA CHAUDRY
Title or Position: DOCTOR
Credential: D.O.
Phone: 201-797-7129