Provider Demographics
NPI:1366502163
Name:BHALLA, ANSHU (MD)
Entity Type:Individual
Prefix:DR
First Name:ANSHU
Middle Name:
Last Name:BHALLA
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 1:2 CENTRE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1564
Mailing Address - Country:US
Mailing Address - Phone:609-395-2470
Mailing Address - Fax:609-860-5288
Practice Address - Street 1:2 CENTRE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-1564
Practice Address - Country:US
Practice Address - Phone:609-395-2470
Practice Address - Fax:609-860-5288
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08180400207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI67162Medicare UPIN