Provider Demographics
NPI:1073816351
Name:BRAHMBHATT, RAVIKUMAR B (MD)
Entity Type:Individual
Prefix:
First Name:RAVIKUMAR
Middle Name:B
Last Name:BRAHMBHATT
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:40 CLIVE HILLS RD
Mailing Address - Street 2:DEPT OF SURGERY
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3653
Mailing Address - Country:US
Mailing Address - Phone:908-217-9441
Mailing Address - Fax:908-217-9441
Practice Address - Street 1:355 GRAND ST, 3 EAST
Practice Address - Street 2:DEPT OF SURGERY
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4321
Practice Address - Country:US
Practice Address - Phone:201-915-2450
Practice Address - Fax:201-915-1282
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2016-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA087586002086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD09771800OtherCDS( CONTROLLED DANGEROUS SUBSTANCE)