Provider Demographics
NPI:1073546495
Name:BHENDE, SUDHIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:
Last Name:BHENDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MADISON AVENUE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-993-9536
Mailing Address - Fax:973-998-4237
Practice Address - Street 1:55 MADISON AVENUE
Practice Address - Street 2:SUITE 310
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-993-9536
Practice Address - Fax:973-998-4237
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03157600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2015901Medicaid
NJ455854MDSMedicare ID - Type Unspecified
NJC55760Medicare UPIN