Provider Demographics
NPI:1124344585
Name:CHOUDHURY, RAFAIE NOMANI
Entity type:Individual
Prefix:
First Name:RAFAIE
Middle Name:NOMANI
Last Name:CHOUDHURY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 E 169TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-2605
Mailing Address - Country:US
Mailing Address - Phone:718-620-9000
Mailing Address - Fax:718-620-6666
Practice Address - Street 1:619 E 169TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-2605
Practice Address - Country:US
Practice Address - Phone:718-620-9000
Practice Address - Fax:718-620-6666
Is Sole Proprietor?:No
Enumeration Date:2010-04-10
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 053927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist