Provider Demographics
NPI:1508933177
Name:BHATIA, VAJRAMALA P (MD)
Entity Type:Individual
Prefix:
First Name:VAJRAMALA
Middle Name:P
Last Name:BHATIA
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 1:4 COLE CT
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-8700
Mailing Address - Country:US
Mailing Address - Phone:732-780-1322
Mailing Address - Fax:732-252-8490
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:AT OSBORNE TERRACE
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ603912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6440002Medicaid
NJF91085Medicare UPIN
NJ096041Medicare ID - Type UnspecifiedNUMBER