Provider Demographics
NPI:1679548929
Name:ASWINI K CHOUDHURY
Entity type:Organization
Organization Name:ASWINI K CHOUDHURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ASWINI
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHOUDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-225-5004
Mailing Address - Street 1:433 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:LAKE CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-6001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:433 ROUTE 52
Practice Address - Street 2:
Practice Address - City:LAKE CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-6001
Practice Address - Country:US
Practice Address - Phone:845-225-5004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154369173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00798581Medicaid
NYA99172Medicare UPIN
NY00798581Medicaid