Provider Demographics
NPI:1548229792
Name:BHATNAGAR, SHAILENDRA (MD)
Entity Type:Individual
Prefix:
First Name:SHAILENDRA
Middle Name:
Last Name:BHATNAGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4610
Mailing Address - Country:US
Mailing Address - Phone:973-740-0607
Mailing Address - Fax:973-436-5660
Practice Address - Street 1:1000 GALLOPING HILL ROAD
Practice Address - Street 2:OVERLOOK HOSPITAL, UNION CAMPUS
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:908-522-6300
Practice Address - Fax:973-436-5660
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255055207P00000X
NY177981-1207P00000X
NC2012-02014207P00000X
NJ25MA05206400207P00000X
RIMD13999207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01147295Medicaid
NJ0432580Medicaid
NJ0432580Medicaid
E43330Medicare UPIN