MEDICARE: CHOWDHURY MEDICAL CARE 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	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	211248	OTHER	NY	NY STATE LICENSE
2	607526764	OTHER	NY	TAX I'D
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467822882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOWDHURY MEDICAL CARE PC

Provider Business Mailing Address
First Line	:	1084 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2923
Country	:	US
Telephone Number	:	718-277-2700
Fax Number	:	718-277-4191

Provider Business Practice Location Address
First Line	:	1084 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2923
Country	:	US
Telephone Number	:	718-277-2700
Fax Number	:	718-277-4191

Authorized Official
Title or Position	:	M.D
Name	:	DR. ASM SHAH ALAM CHOWDHURY
Credential	:	M.D
Telephone Number	:	718-277-2700

Provider Enumeration Date	:	09/28/2015
Last Update Date	:	09/28/2015

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