Provider Demographics
NPI:1164780466
Name:TEKCHAND THAKURDIAL, DPM, P.C.
Entity Type:Organization
Organization Name:TEKCHAND THAKURDIAL, DPM, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TEKCHAND
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKURDIAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-554-4098
Mailing Address - Street 1:4243 RICHMOND AVE 1ST FL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6221
Mailing Address - Country:US
Mailing Address - Phone:718-554-4098
Mailing Address - Fax:718-554-4594
Practice Address - Street 1:4243 RICHMOND AVE, 1ST FL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6221
Practice Address - Country:US
Practice Address - Phone:718-554-4098
Practice Address - Fax:718-554-4594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005476-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty