Provider Demographics
NPI:1003291907
Name:BAHRI, ANKUR (DPM)
Entity Type:Individual
Prefix:
First Name:ANKUR
Middle Name:
Last Name:BAHRI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FAULKNER DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2856
Mailing Address - Country:US
Mailing Address - Phone:732-946-3000
Mailing Address - Fax:732-820-4700
Practice Address - Street 1:485 NEW BRUNSWICK AVE STE 102
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3675
Practice Address - Country:US
Practice Address - Phone:732-946-3000
Practice Address - Fax:732-820-4700
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006951-1213ES0103X
NJ25MD00342900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN006951-1OtherNYS PODIATRY LICENSE
NJ25MD00342900OtherNJ PODIATRY LICENSE