Provider Demographics
NPI:1104830272
Name:BHATT, RUPAL (MD)
Entity Type:Individual
Prefix:
First Name:RUPAL
Middle Name:
Last Name:BHATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 RTE 46 W
Mailing Address - Street 2:STE H105
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2440
Mailing Address - Country:US
Mailing Address - Phone:973-575-8644
Mailing Address - Fax:973-575-8677
Practice Address - Street 1:271 RTE 46 W
Practice Address - Street 2:STE H105
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2440
Practice Address - Country:US
Practice Address - Phone:973-575-8644
Practice Address - Fax:973-575-8677
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07437900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA07437900OtherLICENSE
NJ119442SELMedicare PIN