Provider Demographics
NPI:1225142045
Name:ANJNI G BHAGAT PHYSICIAN P C
Entity Type:Organization
Organization Name:ANJNI G BHAGAT PHYSICIAN P C
Other - Org Name:MAIN STREET MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJNI
Authorized Official - Middle Name:G
Authorized Official - Last Name:BHAGAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-483-0705
Mailing Address - Street 1:5 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1905
Mailing Address - Country:US
Mailing Address - Phone:518-483-0705
Mailing Address - Fax:518-483-1375
Practice Address - Street 1:5 CLAY ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1905
Practice Address - Country:US
Practice Address - Phone:518-483-0705
Practice Address - Fax:518-483-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDB3458OtherRAILROAD MEDICARE
NY02957679Medicaid
NYAA0772Medicare PIN