Healthcare Provider Details

I. General information

NPI: 1902156094
Provider Name (Legal Business Name): HAAMID CHAMDAWALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2012
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

IV. Provider business mailing address

559 SAINT JOHNS PL APT 3R
BROOKLYN NY
11238-5557
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-6209
  • Fax: 718-250-8735
Mailing address:
  • Phone: 718-918-5875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number280362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: