Provider Demographics
NPI:1194742932
Name:DHARIA, SUMIT SHAILESH (DPM)
Entity type:Individual
Prefix:DR
First Name:SUMIT
Middle Name:SHAILESH
Last Name:DHARIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3625
Mailing Address - Country:US
Mailing Address - Phone:516-359-3339
Mailing Address - Fax:718-567-1774
Practice Address - Street 1:100 WILSON BLVD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3625
Practice Address - Country:US
Practice Address - Phone:516-359-3339
Practice Address - Fax:718-567-1774
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006032213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02593988Medicaid
NY02593988Medicaid
NYPJ3202Medicare PIN