Healthcare Provider Details

I. General information

NPI: 1326734740
Provider Name (Legal Business Name): BEHRUJ SHIKDAR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 WILLIS AVE
MINEOLA NY
11501-2616
US

IV. Provider business mailing address

161 WILLIS AVE
MINEOLA NY
11501-2616
US

V. Phone/Fax

Practice location:
  • Phone: 516-280-6645
  • Fax: 516-414-0273
Mailing address:
  • Phone: 516-280-6645
  • Fax: 516-414-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN007509-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: