Basic Information
Provider Information
NPI: 1730610288
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAUDHRY
FirstName: JUNAID
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 325 MERCER LOOP
Address2:  
City: JERSEY CITY
State: NJ
PostalCode: 073023232
CountryCode: US
TelephoneNumber: 2017619397
FaxNumber:  
Practice Location
Address1: 1400 PELHAM PKWY S
Address2: BUILDING 6//SUITE B125
City: BRONX
State: NY
PostalCode: 104611138
CountryCode: US
TelephoneNumber: 7189185820
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/27/2017
LastUpdateDate: 03/27/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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