Provider Demographics
NPI:1063856128
Name:JAYATI C. BHATTACHARYYA DDS PC
Entity Type:Organization
Organization Name:JAYATI C. BHATTACHARYYA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYATI
Authorized Official - Middle Name:C
Authorized Official - Last Name:BHATTACHARYYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-739-3535
Mailing Address - Street 1:702 N BEERS ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1510
Mailing Address - Country:US
Mailing Address - Phone:732-739-3535
Mailing Address - Fax:
Practice Address - Street 1:702 N BEERS ST STE 3
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1510
Practice Address - Country:US
Practice Address - Phone:732-739-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102331201261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental