Provider Demographics
NPI:1114171717
Name:DR ANCHAL DUREJA DPM, PC
Entity Type:Organization
Organization Name:DR ANCHAL DUREJA DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:ANCHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUREJA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-433-5435
Mailing Address - Street 1:225 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5845
Mailing Address - Country:US
Mailing Address - Phone:516-433-5435
Mailing Address - Fax:
Practice Address - Street 1:225 LEE AVE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5845
Practice Address - Country:US
Practice Address - Phone:516-433-5435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-09
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006178213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02961457Medicaid
NYP99231Medicare PIN