Healthcare Provider Details

I. General information

NPI: 1003602442
Provider Name (Legal Business Name): FAIZA CHOUDHRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 RIVERSIDE DR
BINGHAMTON NY
13905-4246
US

IV. Provider business mailing address

7600 RIVER RD
NORTH BERGEN NJ
07047-6217
US

V. Phone/Fax

Practice location:
  • Phone: 607-789-5725
  • Fax: 607-798-5069
Mailing address:
  • Phone: 201-854-5713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: