Provider Demographics
NPI:1447516737
Name:CITI WIDE PODIATRY PC
Entity type:Organization
Organization Name:CITI WIDE PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASIMA
Authorized Official - Middle Name:RAFIQ
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-315-4168
Mailing Address - Street 1:2727 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5507
Mailing Address - Country:US
Mailing Address - Phone:201-333-2700
Mailing Address - Fax:212-996-5562
Practice Address - Street 1:2727 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5507
Practice Address - Country:US
Practice Address - Phone:201-333-2700
Practice Address - Fax:212-996-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006361213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1497073258Medicaid