Provider Demographics
NPI:1457766495
Name:GHOSH, PAYEL (DPM)
Entity Type:Individual
Prefix:
First Name:PAYEL
Middle Name:
Last Name:GHOSH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 BOSTON POST RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538
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:STE 200
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538
Practice Address - Country:US
Practice Address - Phone:914-834-0111
Practice Address - Fax:914-834-0259
Is Sole Proprietor?:No
Enumeration Date:2014-06-28
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC0065444213ES0103X
NY006865213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04842059Medicaid