Provider Demographics
NPI:1538142955
Name:THAKURDIAL, TEKCHAND (DPM)
Entity Type:Individual
Prefix:DR
First Name:TEKCHAND
Middle Name:
Last Name:THAKURDIAL
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 1:628 BEVERLEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3202
Mailing Address - Country:US
Mailing Address - Phone:718-431-8885
Mailing Address - Fax:718-431-2966
Practice Address - Street 1:628 BEVERLEY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3202
Practice Address - Country:US
Practice Address - Phone:718-431-8885
Practice Address - Fax:718-431-2966
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005476213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01891501Medicaid
NYPB0122Medicare PIN
NY01891501Medicaid