Healthcare Provider Details

I. General information

NPI: 1891241725
Provider Name (Legal Business Name): LARCHMONT PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 BOSTON POST RD SUITE 200
LARCHMONT NY
10538-3500
US

IV. Provider business mailing address

2365 BOSTON POST RD SUITE 200
LARCHMONT NY
10538-3500
US

V. Phone/Fax

Practice location:
  • Phone: 914-834-0111
  • Fax: 914-834-0259
Mailing address:
  • Phone: 914-834-0111
  • Fax: 914-834-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number04132
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ADEEN KHOKHAR
Title or Position: OWNER
Credential: D.P.M.
Phone: 914-834-0111