Provider Demographics
NPI:1225405582
Name:BHATHIJA, OM
Entity Type:Individual
Prefix:
First Name:OM
Middle Name:
Last Name:BHATHIJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3892
Mailing Address - Country:US
Mailing Address - Phone:631-774-5155
Mailing Address - Fax:
Practice Address - Street 1:4 CYPRESS CT
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3892
Practice Address - Country:US
Practice Address - Phone:631-774-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi