Healthcare Provider Details

I. General information

NPI: 1154589026
Provider Name (Legal Business Name): SHAMIMA CHOWDHURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WEST 4TH STREET MOUNT VERNON NEIGHBORHOOD HEALTH CENTER
MOUNT VERNON NY
10550
US

IV. Provider business mailing address

107 WEST 4TH STREET MOUNT VERNON NEIGHBORHOOD HEALTH CENTER
MOUNT VERNON NY
10550
US

V. Phone/Fax

Practice location:
  • Phone: 914-699-7200
  • Fax: 914-699-0837
Mailing address:
  • Phone: 914-699-7200
  • Fax: 914-699-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number273147
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: