Provider Demographics
NPI:1568626034
Name:OZA, RUPAL (DPM)
Entity Type:Individual
Prefix:
First Name:RUPAL
Middle Name:
Last Name:OZA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 28TH ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2096
Mailing Address - Country:US
Mailing Address - Phone:347-615-2508
Mailing Address - Fax:
Practice Address - Street 1:2791 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1833
Practice Address - Country:US
Practice Address - Phone:516-826-9000
Practice Address - Fax:516-826-9036
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006429213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006429OtherLICENSE