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General NPI Number Information
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NPI Number | 1942340948
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Entity Type | Organization
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Legal Business Name | STATEN ISLAND PODIATRY, P.C.
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 364 EDISON ST
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City | STATEN ISLAND
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State | NY
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Zip | 10306-3041
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Country | US
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Telephone | 718-524-4112
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Fax | 718-524-4189
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Provider Business Mailing Address
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Address Line | 364 EDISON ST
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City | STATEN ISLAND
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State | NY
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Zip | 10306-3041
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Country | US
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Telephone | 718-524-4112
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Fax | 718-524-4189
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSHEEL BATHLA
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Credential | M.D
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Telephone | 917-826-5709
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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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