Provider Demographics
NPI:1417307927
Name:CANDARA, THOMAS LAWRENCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LAWRENCE
Last Name:CANDARA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:612 CORPORATE WAY STE 2M
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2027
Mailing Address - Country:US
Mailing Address - Phone:718-362-1411
Mailing Address - Fax:718-414-1651
Practice Address - Street 1:2215 BURDETT AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2466
Practice Address - Country:US
Practice Address - Phone:718-362-8182
Practice Address - Fax:718-414-1651
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN007006213EP1101X, 213ES0131X, 261QP1100X, 213E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program