Provider Demographics
NPI:1184654162
Name:BHALLA, RAHULDEV S (MD)
Entity Type:Individual
Prefix:
First Name:RAHULDEV
Middle Name:S
Last Name:BHALLA
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:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-444-6270
Mailing Address - Fax:631-444-6410
Practice Address - Street 1:24 RESEARCH WAY
Practice Address - Street 2:SUITE 500
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-444-6720
Practice Address - Fax:631-444-6410
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245155208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0059242Medicaid
H96954Medicare UPIN
NJ0059242Medicaid