Provider Demographics
NPI:1275610982
Name:TEJ PODIATRIC GROUP P.C
Entity Type:Organization
Organization Name:TEJ PODIATRIC GROUP P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JIGNASA
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-369-7340
Mailing Address - Street 1:33 W 125TH ST
Mailing Address - Street 2:2ND FLOOR ROOM #5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4512
Mailing Address - Country:US
Mailing Address - Phone:212-369-7340
Mailing Address - Fax:212-369-1071
Practice Address - Street 1:33 W 125TH ST
Practice Address - Street 2:2ND FLOOR ROOM #5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4512
Practice Address - Country:US
Practice Address - Phone:212-369-7340
Practice Address - Fax:212-369-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004752-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5434340001Medicare NSC
NYWFW561Medicare PIN