Individual
SOURAB CHOUDHURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
161 ATLANTIC AVE, SUITE 202, BROOKLYN, NY 11201-6720
(718) 797-5504
Mailing address
161 ATLANTIC AVE, SUITE 202, BROOKLYN, NY 11201-6720
(718) 797-5504
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
226018
NY
207NP0225X
Pediatric Dermatology Physician
226018
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02358652
—
NY
Enumeration date
03/31/2006
Last updated
12/17/2007
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