Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 25MD00342900 | NJ |
Y | 213ES0103X | Foot & Ankle Surgery | N006951-1 | NY |
NPI | 1003291907 |
---|---|
Provider Name | Ankur Bahri |
First Address | Edgewater, NJ 07020-3113 |
Second Address | New York, NY 10001-3841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2015 |
Last Update Date | 28/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MD00342900 | NJ PODIATRY LICENSE (01) | NJ |
N006951-1 | NYS PODIATRY LICENSE (01) | NY |