Provider Demographics
NPI:1760440283
Name:NAIK, HETAL (DPM)
Entity Type:Individual
Prefix:DR
First Name:HETAL
Middle Name:
Last Name:NAIK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MRS
Other - First Name:HETAL
Other - Middle Name:NILAY
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:129 MOSEL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4467
Mailing Address - Country:US
Mailing Address - Phone:718-727-8876
Mailing Address - Fax:718-727-8876
Practice Address - Street 1:1417 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1726
Practice Address - Country:US
Practice Address - Phone:718-421-6300
Practice Address - Fax:718-421-6001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005552213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02128403Medicaid
NYPB5791Medicare ID - Type Unspecified
NYU79533Medicare UPIN