Healthcare Provider Details

I. General information

NPI: 1639081573
Provider Name (Legal Business Name): BAHRI GAUDINO PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35-37 PROGRESS ST STE A3
EDISON NJ
08820-1179
US

IV. Provider business mailing address

35-37 PROGRESS ST STE A3
EDISON NJ
08820-1179
US

V. Phone/Fax

Practice location:
  • Phone: 445-205-9768
  • Fax: 877-341-4172
Mailing address:
  • Phone: 445-205-9768
  • Fax: 877-341-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANKUR BAHRI
Title or Position: CEO
Credential: DPM
Phone: 445-205-9768