Healthcare Provider Details

I. General information

NPI: 1639168933
Provider Name (Legal Business Name): IFTIKHAR-AHMAD SHAHID CHOUHDRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 HARRIS RD
FERNDALE NY
12734-5142
US

IV. Provider business mailing address

653 HARRIS RD
FERNDALE NY
12734-5142
US

V. Phone/Fax

Practice location:
  • Phone: 845-807-3635
  • Fax:
Mailing address:
  • Phone: 845-807-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number165122
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: