Provider Demographics
NPI:1720689102
Name:FOOT AND SOUL
Entity Type:Organization
Organization Name:FOOT AND SOUL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSHEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BATHLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-826-5709
Mailing Address - Street 1:1 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08608-1205
Mailing Address - Country:US
Mailing Address - Phone:917-826-5709
Mailing Address - Fax:
Practice Address - Street 1:1 W STATE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608-1205
Practice Address - Country:US
Practice Address - Phone:917-826-5709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty