MEDICARE: PATHAK PODIATRY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1588045330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHAK PODIATRY PC

Provider Business Mailing Address
First Line	:	2502 86TH ST
Second Line	:	3RD FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4440
Country	:	US
Telephone Number	:	347-721-9876
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 86TH ST
Second Line	:	3RD FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4440
Country	:	US
Telephone Number	:	347-721-9876
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	NEHA J PATHAK
Credential	:	DPM
Telephone Number	:	614-537-2453

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	06/17/2015

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