Healthcare Provider Details

I. General information

NPI: 1295885259
Provider Name (Legal Business Name): PRAVEEN KUMRAH PODIATRY P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 KINGSBRIDGE AVE
BRONX NY
10463-3956
US

IV. Provider business mailing address

133 FINCH ROAD
RINGWOOD NJ
07456
US

V. Phone/Fax

Practice location:
  • Phone: 718-548-1102
  • Fax: 718-548-1103
Mailing address:
  • Phone: 973-831-2177
  • Fax: 973-839-4684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberNOO5801
License Number StateNY

VIII. Authorized Official

Name: PRAVEEN KUMRAH
Title or Position: PRESIDENT
Credential: D.P.M
Phone: 973-831-2177