Provider Demographics
NPI:1891241725
Name:LARCHMONT PODIATRY PLLC
Entity Type:Organization
Organization Name:LARCHMONT PODIATRY PLLC
Other - Org Name:CERTIFIED FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-834-0111
Mailing Address - Street 1:2365 BOSTON POST RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3500
Mailing Address - Country:US
Mailing Address - Phone:914-834-0111
Mailing Address - Fax:914-834-0259
Practice Address - Street 1:2365 BOSTON POST RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3500
Practice Address - Country:US
Practice Address - Phone:914-834-0111
Practice Address - Fax:914-834-0259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04132213ES0000X
261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07536583Medicaid
NY1730719360OtherNPI