Provider Demographics
NPI:1134563885
Name:DURBHAKA, VENKATA L (DPM, MS)
Entity type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:L
Last Name:DURBHAKA
Suffix:
Gender:F
Credentials:DPM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 CRESTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4244
Mailing Address - Country:US
Mailing Address - Phone:718-294-6200
Mailing Address - Fax:
Practice Address - Street 1:2024 CRESTON AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-4244
Practice Address - Country:US
Practice Address - Phone:718-294-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006562213E00000X
CT000873213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery