Provider Demographics
NPI:1285668871
Name:BHATTY, ANIS (MD)
Entity Type:Individual
Prefix:
First Name:ANIS
Middle Name:
Last Name:BHATTY
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 1:1 BROADWAY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1842
Mailing Address - Country:US
Mailing Address - Phone:201-794-8855
Mailing Address - Fax:201-794-6988
Practice Address - Street 1:1 BROADWAY
Practice Address - Street 2:SUITE 303
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1842
Practice Address - Country:US
Practice Address - Phone:201-794-8855
Practice Address - Fax:201-794-6988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40211208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ317521OtherEMPIRE
NJ01000452700OtherAMERICHOICE
NJ0984697004OtherCIGNA
NJOK2765OtherHEALTHNET
NJPP071OtherOXFORD
NJ1028441OtherHORIZON MERCY
NJ184090801Medicaid
NJJ5146OtherHORIZON
NJ4197029OtherAETNA
NJ510452OtherUNITED HEALTHCARE
NJ10832OtherAMERIGROUP
NJ10832OtherAMERIGROUP