Provider Demographics
NPI:1497252142
Name:DR. JAY BHUTA PC
Entity Type:Organization
Organization Name:DR. JAY BHUTA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:NALIN
Authorized Official - Last Name:BHUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-532-3668
Mailing Address - Street 1:225 MILLBURN AVE STE 104B
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1712
Mailing Address - Country:US
Mailing Address - Phone:732-532-3668
Mailing Address - Fax:973-577-4003
Practice Address - Street 1:200 S ORANGE AVE STE 118
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:732-532-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP1100X
NJ25MD00325500332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies