Basic Information
| Provider Information | |||||||||
| NPI: | 1912262734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOWDHURY | ||||||||
| FirstName: | DOLAN | ||||||||
| MiddleName: | KUMAR | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1434 WILLIAMSBRIDGE RD FL 2 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186180401 | ||||||||
| FaxNumber: | 3474791303 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 HAMBURG TPKE STE 108 | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074702033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739254111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2012 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 25MD00342000 | NJ | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 213E00000X | N006635 | NY | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.