Healthcare Provider Details

I. General information

NPI: 1942340948
Provider Name (Legal Business Name): STATEN ISLAND PODIATRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 EDISON ST
STATEN ISLAND NY
10306-3041
US

IV. Provider business mailing address

364 EDISON ST
STATEN ISLAND NY
10306-3041
US

V. Phone/Fax

Practice location:
  • Phone: 718-524-4112
  • Fax: 718-524-4189
Mailing address:
  • Phone: 718-524-4112
  • Fax: 718-524-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SUSHEEL BATHLA
Title or Position: PRESIDENT
Credential: M.D
Phone: 917-826-5709