Healthcare Provider Details

I. General information

NPI: 1760709505
Provider Name (Legal Business Name): RICHMOND PODIATRY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4243 RICHMOND AVE.
STATEN ISLAND NY
10312-6238
US

IV. Provider business mailing address

4243 RICHMOND AVE.
STATEN ISLAND NY
10312-6238
US

V. Phone/Fax

Practice location:
  • Phone: 718-431-8885
  • Fax: 718-431-2966
Mailing address:
  • Phone: 718-431-8885
  • Fax: 718-431-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005476
License Number StateNY

VIII. Authorized Official

Name: DR. TEKCHAND THAKURDIAL
Title or Position: CO-OWNER
Credential: D.P.M.
Phone: 718-431-8885