Healthcare Provider Details

I. General information

NPI: 1720029770
Provider Name (Legal Business Name): SAMINA CHOUDRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2834 RT. 17M MID-HUDSON FORENSIC PSYCHIATRIC CENTER,
NEW HAMPTON NY
10958-0158
US

IV. Provider business mailing address

2834 RT. 17M MID-HUDSON FORENSIC PSYCHIATRIC CENTER,
NEW HAMPTON NY
10958-0158
US

V. Phone/Fax

Practice location:
  • Phone: 845-283-3847
  • Fax:
Mailing address:
  • Phone: 845-283-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number203922
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number203922
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: