Healthcare Provider Details

I. General information

NPI: 1912977364
Provider Name (Legal Business Name): IMTIYAZ I KAPADWALA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220A SAINT NICHOLAS AVE
BROOKLYN NY
11237-4807
US

IV. Provider business mailing address

1309 HARBOR RD
HEWLETT NY
11557-2640
US

V. Phone/Fax

Practice location:
  • Phone: 718-418-8540
  • Fax:
Mailing address:
  • Phone: 718-418-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005412
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberNOO5412
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: