Healthcare Provider Details

I. General information

NPI: 1598861767
Provider Name (Legal Business Name): REZA CHOWDHURY MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 WESTCHESTER AVE
BRONX NY
10462-4505
US

IV. Provider business mailing address

1957 WESTCHESTER AVENUE
BRONX NY
10462-4505
US

V. Phone/Fax

Practice location:
  • Phone: 347-851-6633
  • Fax: 347-851-6635
Mailing address:
  • Phone: 347-851-6633
  • Fax: 347-851-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number241737
License Number StateNY

VIII. Authorized Official

Name: DR. REZA CHOWDHURY
Title or Position: PHYSICIAN, CEO
Credential: MD
Phone: 347-851-6633