Provider Demographics
NPI:1508011719
Name:BATHINI, MANJULA (DO)
Entity Type:Individual
Prefix:DR
First Name:MANJULA
Middle Name:
Last Name:BATHINI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MADISON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1868
Mailing Address - Country:US
Mailing Address - Phone:973-822-2772
Mailing Address - Fax:973-822-2773
Practice Address - Street 1:300 MADISON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1868
Practice Address - Country:US
Practice Address - Phone:973-822-2772
Practice Address - Fax:973-822-2773
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB078311002084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ263944134OtherHORIZON