MEDICARE: CITI WIDE PODIATRY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	006361	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447516737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITI WIDE PODIATRY PC

Provider Business Mailing Address
First Line	:	2727 KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5507
Country	:	US
Telephone Number	:	201-333-2700
Fax Number	:	212-996-5562

Provider Business Practice Location Address
First Line	:	2727 KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5507
Country	:	US
Telephone Number	:	201-333-2700
Fax Number	:	212-996-5562

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. ASIMA RAFIQ CHAUDHRY
Credential	:	DPM
Telephone Number	:	201-315-4168

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	01/20/2021

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