Healthcare Provider Details

I. General information

NPI: 1205916038
Provider Name (Legal Business Name): OSCAR CHAMUDES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3187 STEINWAY ST STE 6
ASTORIA NY
11103-3952
US

IV. Provider business mailing address

31-87 STEINWAY ST SUITE#6
ASTORIA NY
11103-3952
US

V. Phone/Fax

Practice location:
  • Phone: 718-626-4881
  • Fax: 718-626-5102
Mailing address:
  • Phone: 718-626-4881
  • Fax: 718-626-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number135195-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00298980
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: