Provider Demographics
NPI:1033644737
Name:PANCHAL, NIKUL
Entity Type:Individual
Prefix:
First Name:NIKUL
Middle Name:
Last Name:PANCHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ESSEX ST STE 405
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3247
Mailing Address - Country:US
Mailing Address - Phone:732-421-6907
Mailing Address - Fax:
Practice Address - Street 1:211 ESSEX ST STE 405
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3247
Practice Address - Country:US
Practice Address - Phone:732-421-6907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00362900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery