Provider Demographics
NPI:1578115523
Name:DUA, DOLLY (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOLLY
Middle Name:
Last Name:DUA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:DOLLY
Other - Middle Name:
Other - Last Name:DUA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:ST BARNABAS PODIATRY 4487 3RD AVE, THE BRONX, NY 10457
Mailing Address - Street 2:
Mailing Address - City:THE BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4487 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1526
Practice Address - Country:US
Practice Address - Phone:718-414-4780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program