Healthcare Provider Details

I. General information

NPI: 1679548929
Provider Name (Legal Business Name): ASWINI K CHOUDHURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 ROUTE 52
LAKE CARMEL NY
10512-6001
US

IV. Provider business mailing address

433 ROUTE 52
LAKE CARMEL NY
10512-6001
US

V. Phone/Fax

Practice location:
  • Phone: 845-225-5004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number154369
License Number StateNY

VIII. Authorized Official

Name: ASWINI K CHOUDHURY
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 845-225-5004