Provider Demographics
NPI:1366604605
Name:CHAUDRY, SAMIA RIAZ (DO)
Entity type:Individual
Prefix:
First Name:SAMIA
Middle Name:RIAZ
Last Name:CHAUDRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-04 GOLDBLATT TER
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5911
Mailing Address - Country:US
Mailing Address - Phone:201-797-7129
Mailing Address - Fax:201-703-6982
Practice Address - Street 1:41 04 GOLDBLATT TERRACE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5911
Practice Address - Country:US
Practice Address - Phone:201-797-7129
Practice Address - Fax:201-703-6982
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08847900207Q00000X
NY277474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine