Provider Demographics
NPI:1336347103
Name:PANDYA, TEJAS RAMESH (DPM)
Entity Type:Individual
Prefix:DR
First Name:TEJAS
Middle Name:RAMESH
Last Name:PANDYA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
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 1:763 HOOSICK STREET
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-6646
Practice Address - Country:US
Practice Address - Phone:518-273-0053
Practice Address - Fax:518-271-2052
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005891213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD6529Medicare PIN
NYRA0616Medicare PIN
NYU96269Medicare UPIN
NYRB3365Medicare PIN