Basic Information
Provider Information | |||||||||
NPI: | 1528048527 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHOWDHURY | ||||||||
FirstName: | ZINNAT | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ARA | ||||||||
OtherFirstName: | ZINNAT | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 400 LAUREL OAK RD STE 105 | ||||||||
Address2: |   | ||||||||
City: | VOORHEES | ||||||||
State: | NJ | ||||||||
PostalCode: | 080434455 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8569229894 | ||||||||
FaxNumber: | 8569229890 | ||||||||
Practice Location | |||||||||
Address1: | 151 FRIES MILL RD STE 301 | ||||||||
Address2: |   | ||||||||
City: | TURNERSVILLE | ||||||||
State: | NJ | ||||||||
PostalCode: | 080122016 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8565134124 | ||||||||
FaxNumber: | 8565666419 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/18/2006 | ||||||||
LastUpdateDate: | 01/15/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/15/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MA07323600 | NJ | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 8642605 | 05 | NJ |   | MEDICAID |