Provider Demographics
NPI:1568680841
Name:MADHURI BEWTRA, M.D., LLC
Entity Type:Organization
Organization Name:MADHURI BEWTRA, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHURI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEWTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-871-4346
Mailing Address - Street 1:405A SOUTH VAN BRUNT ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-4604
Mailing Address - Country:US
Mailing Address - Phone:201-871-4346
Mailing Address - Fax:201-871-5953
Practice Address - Street 1:405A SOUTH VAN BRUNT ST
Practice Address - Street 2:SUITE 405
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07646-4604
Practice Address - Country:US
Practice Address - Phone:201-871-4346
Practice Address - Fax:201-871-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJH49244207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ119386Medicare UPIN