Healthcare Provider Details

I. General information

NPI: 1790763530
Provider Name (Legal Business Name): STERLING CHUDOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HIGH RIDGE RD
WARWICK NY
10990-2649
US

IV. Provider business mailing address

24 HIGH RIDGE RD
WARWICK NY
10990-2649
US

V. Phone/Fax

Practice location:
  • Phone: 845-986-9986
  • Fax: 845-783-7133
Mailing address:
  • Phone: 845-986-9986
  • Fax: 845-783-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number131033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: