Provider Demographics
NPI:1033693007
Name:CHOUDHURY, ADIBA (RN)
Entity type:Individual
Prefix:MISS
First Name:ADIBA
Middle Name:
Last Name:CHOUDHURY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 SPRINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6061
Mailing Address - Country:US
Mailing Address - Phone:631-575-7176
Mailing Address - Fax:
Practice Address - Street 1:276 SPRINGDALE DR
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6061
Practice Address - Country:US
Practice Address - Phone:631-575-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY755311163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse