Provider Demographics
NPI:1699435883
Name:CAPITAL DISTRICT PODIATRY, PLLC
Entity type:Organization
Organization Name:CAPITAL DISTRICT PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:RAMESH
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-273-0053
Mailing Address - Street 1:763 HOOSICK RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-6666
Mailing Address - Country:US
Mailing Address - Phone:518-273-0053
Mailing Address - Fax:518-271-2052
Practice Address - Street 1:855 ROUTE 146 BLDG B
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3885
Practice Address - Country:US
Practice Address - Phone:518-982-1065
Practice Address - Fax:518-271-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty