Provider Demographics
NPI:1851580138
Name:CAPITAL DISTRICT PODIATRY, PLLC
Entity Type:Organization
Organization Name:CAPITAL DISTRICT PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-273-0053
Mailing Address - Street 1:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-0803
Mailing Address - Country:US
Mailing Address - Phone:518-273-0053
Mailing Address - Fax:518-271-2052
Practice Address - Street 1:1 TALLOW WOOD DR
Practice Address - Street 2:SUITE 7
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2807
Practice Address - Country:US
Practice Address - Phone:518-273-0053
Practice Address - Fax:518-271-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005891-2213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0067Medicare PIN
NY4927110002Medicare NSC