Provider Demographics
NPI:1801980016
Name:CAPITAL DISTRICT PODIATRY, PLLC
Entity type:Organization
Organization Name:CAPITAL DISTRICT PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/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:MD
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:518-271-2025
Practice Address - Street 1:763 HOOSICK RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-6666
Practice Address - Country:US
Practice Address - Phone:518-273-0053
Practice Address - Fax:518-271-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005891213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU96269Medicare UPIN
NYAA1678Medicare PIN
NY4927110001Medicare NSC