Healthcare Provider Details

I. General information

NPI: 1801942065
Provider Name (Legal Business Name): DEVINDRA POONAI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 LIVINGSTON AVE
NORTH BRUNSWICK NJ
08902-2443
US

IV. Provider business mailing address

602 LIVINGSTON AVE
NORTH BRUNSWICK NJ
08902-2443
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-1377
  • Fax: 732-246-0858
Mailing address:
  • Phone: 732-246-1377
  • Fax: 732-246-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberMD02222
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberMD02222
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD02222
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: