Provider Demographics
NPI:1619403128
Name:BHARGAVA, POOJA (DO)
Entity Type:Individual
Prefix:DR
First Name:POOJA
Middle Name:
Last Name:BHARGAVA
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 1:200 SOUTH ORANGE AVE SUITE 101
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:212-280-4740
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTH ORANGE AVE SUITE 101
Practice Address - Street 2:
Practice Address - City:LIVINGSTEN
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-322-7095
Practice Address - Fax:212-280-4743
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314526207R00000X
PAOT017732390200000X
NJ25MA11717800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANONEMedicaid