Provider Demographics
NPI:1376620591
Name:BHATTY, MANSUKH M (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSUKH
Middle Name:M
Last Name:BHATTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 WESKORA AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2716
Mailing Address - Country:US
Mailing Address - Phone:914-769-0363
Mailing Address - Fax:
Practice Address - Street 1:234 EAST 149TH STREET
Practice Address - Street 2:LINCOLN HOSPITAL, SUITE #103
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-5190
Practice Address - Fax:718-579-5045
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1396832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00567515Medicaid
NYF38021Medicare UPIN