Provider Demographics
NPI:1164170866
Name:DUDANI, BHAKTI JAIDEEP (PA-C)
Entity Type:Individual
Prefix:
First Name:BHAKTI
Middle Name:JAIDEEP
Last Name:DUDANI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 EMERSON RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:556 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7449
Practice Address - Country:US
Practice Address - Phone:973-808-2273
Practice Address - Fax:973-808-2287
Is Sole Proprietor?:No
Enumeration Date:2022-03-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00821000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant