Basic Information
Provider Information
NPI: 1003291907
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAHRI
FirstName: ANKUR
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 226 RIVER MEWS LN
Address2:  
City: EDGEWATER
State: NJ
PostalCode: 070203113
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 39 W 32ND ST RM 1503
Address2:  
City: NEW YORK
State: NY
PostalCode: 100013841
CountryCode: US
TelephoneNumber: 3477027900
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/21/2015
LastUpdateDate: 08/28/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213ES0103X25MD00342900NJN193400000X SINGLE SPECIALTY GROUPPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
213ES0103XN006951-1NYY Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery

ID Information
IDTypeStateIssuerDescription
N006951-101NYNYS PODIATRY LICENSEOTHER
25MD0034290001NJNJ PODIATRY LICENSEOTHER


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