Provider Demographics
NPI:1871596387
Name:BATHLA, SUSHEEL (DPM)
Entity type:Individual
Prefix:DR
First Name:SUSHEEL
Middle Name:
Last Name:BATHLA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6222
Mailing Address - Country:US
Mailing Address - Phone:718-524-4112
Mailing Address - Fax:718-524-4189
Practice Address - Street 1:364 EDISON ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3041
Practice Address - Country:US
Practice Address - Phone:718-524-4112
Practice Address - Fax:718-524-4189
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005417213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01918189Medicaid
NYPB6331Medicare ID - Type Unspecified
NY5077020001Medicare NSC
NYU70421Medicare UPIN