Provider Demographics
NPI:1720063233
Name:KATRIYAR, AMBIKA (DPM)
Entity type:Individual
Prefix:DR
First Name:AMBIKA
Middle Name:
Last Name:KATRIYAR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:AMBIKA
Other - Middle Name:
Other - Last Name:MATHUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:6 BELKNAP CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4897
Mailing Address - Country:US
Mailing Address - Phone:516-592-7218
Mailing Address - Fax:631-239-5821
Practice Address - Street 1:6 BELKNAP CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4897
Practice Address - Country:US
Practice Address - Phone:516-592-7218
Practice Address - Fax:631-239-5821
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005770-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004240347Medicaid
CT480000932Medicare ID - Type Unspecified
NYPG6041Medicare ID - Type Unspecified
CT004240347Medicaid