Healthcare Provider Details

I. General information

NPI: 1417311580
Provider Name (Legal Business Name): MRS. BOBBI-JO G CHOUDHURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 85TH ST
NEW YORK NY
10028-3135
US

IV. Provider business mailing address

150 E 42ND ST # 1118
NEW YORK NY
10017-5612
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6585
  • Fax:
Mailing address:
  • Phone: 646-605-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340242-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: