Healthcare Provider Details

I. General information

NPI: 1538266168
Provider Name (Legal Business Name): ASM JUNNUN CHOUDHURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST
JAMAICA NY
11432-1121
US

IV. Provider business mailing address

8732 167TH ST FL 1
JAMAICA NY
11432-3636
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-2971
  • Fax: 718-883-6167
Mailing address:
  • Phone: 718-739-3145
  • Fax: 718-558-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number218767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: