Basic Information
| Provider Information | |||||||||
| NPI: | 1649884966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAHRI PODIATRY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 226 RIVER MEWS LN | ||||||||
| Address2: | |||||||||
| City: | EDGEWATER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070203113 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 140 N RTE 17 STE 103 | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076522809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3477027900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2020 | ||||||||
| LastUpdateDate: | 09/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | BAHRI | ||||||||
| AuthorizedOfficialFirstName: | ANKUR | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9738835284 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 09/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 25MD00342900 | 01 | NJ | NJ PODIATRY LICENSE | OTHER | N006951-1 | 01 | NY | NY PODIATRY LICENSE | OTHER |