Provider Demographics
NPI:1477226884
Name:BHANUSHALI, NEETU
Entity Type:Individual
Prefix:
First Name:NEETU
Middle Name:
Last Name:BHANUSHALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E HENRY PL
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-1218
Mailing Address - Country:US
Mailing Address - Phone:239-321-9837
Mailing Address - Fax:
Practice Address - Street 1:1024 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3026
Practice Address - Country:US
Practice Address - Phone:908-633-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102851800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist