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General NPI Number Information
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NPI Number | 1699435883
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Entity Type | Organization
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Legal Business Name | CAPITAL DISTRICT PODIATRY, PLLC
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Dates
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Enumeration Date | 12/29/2021
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 855 ROUTE 146 BLDG B
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City | CLIFTON PARK
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State | NY
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Zip | 12065-3885
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Country | US
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Telephone | 518-982-1065
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Fax | 518-271-2052
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Provider Business Mailing Address
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Address Line | 763 HOOSICK RD
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City | TROY
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State | NY
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Zip | 12180-6666
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Country | US
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Telephone | 518-273-0053
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Fax | 518-271-2052
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Authorized Official
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Title or Position | OWNER
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Name | TEJAS RAMESH PANDYA
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Credential | DPM
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Telephone | 518-273-0053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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