Provider Demographics
NPI:1376537985
Name:CHOPRA, JAIDEEP (DPM)
Entity Type:Individual
Prefix:
First Name:JAIDEEP
Middle Name:
Last Name:CHOPRA
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 1:1120 WARBURTON AVE
Mailing Address - Street 2:4E
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1054
Mailing Address - Country:US
Mailing Address - Phone:215-668-6814
Mailing Address - Fax:888-675-7565
Practice Address - Street 1:1324 BERGEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1530
Practice Address - Country:US
Practice Address - Phone:718-774-5224
Practice Address - Fax:888-675-7565
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005517207XX0004X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00970654Medicaid
NYPB2722Medicare PIN
NYU77746Medicare UPIN