Provider Demographics
NPI:1073698049
Name:DASANI, BHARAT (MD)
Entity Type:Individual
Prefix:
First Name:BHARAT
Middle Name:
Last Name:DASANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BHARAT
Other - Middle Name:
Other - Last Name:DASANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:44 ROUTE 23 NORTH
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457
Mailing Address - Country:US
Mailing Address - Phone:973-248-1550
Mailing Address - Fax:973-248-1560
Practice Address - Street 1:44 ROUTE 23 NORTH
Practice Address - Street 2:SUITE 7
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457
Practice Address - Country:US
Practice Address - Phone:973-248-1550
Practice Address - Fax:973-248-1560
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ57951207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5445701Medicaid
NJ5445701Medicaid