Healthcare Provider Details

I. General information

NPI: 1588045330
Provider Name (Legal Business Name): PATHAK PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 86TH ST 3RD FLOOR
BROOKLYN NY
11214-4440
US

IV. Provider business mailing address

2502 86TH ST 3RD FLOOR
BROOKLYN NY
11214-4440
US

V. Phone/Fax

Practice location:
  • Phone: 347-721-9876
  • Fax:
Mailing address:
  • Phone: 347-721-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NEHA J PATHAK
Title or Position: BUSINESS OWNER
Credential: DPM
Phone: 614-537-2453