Provider Demographics
NPI:1295885259
Name:PRAVEEN KUMRAH PODIATRY P.C
Entity type:Organization
Organization Name:PRAVEEN KUMRAH PODIATRY P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMRAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-831-2177
Mailing Address - Street 1:133 FINCH ROAD
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456
Mailing Address - Country:US
Mailing Address - Phone:973-831-2177
Mailing Address - Fax:973-839-4684
Practice Address - Street 1:3108 KINGSBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3956
Practice Address - Country:US
Practice Address - Phone:718-548-1102
Practice Address - Fax:718-548-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO5801213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5417330001Medicare NSC