Provider Demographics
NPI:1093753923
Name:BAPANA, EMMANUEL V (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:V
Last Name:BAPANA
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 1:455 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2641
Mailing Address - Country:US
Mailing Address - Phone:551-486-0342
Mailing Address - Fax:201-943-6980
Practice Address - Street 1:2209 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5930
Practice Address - Country:US
Practice Address - Phone:551-486-0342
Practice Address - Fax:201-943-6980
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199854207R00000X
NJ25MA06289500207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01883114Medicaid
NJ8806403Medicaid
NJ8806403Medicaid
P00434820Medicare PIN
NJG24582Medicare UPIN
NY400951Medicare PIN