Provider Demographics
NPI:1639140577
Name:BHARATIYA, PURABI (MD)
Entity Type:Individual
Prefix:
First Name:PURABI
Middle Name:
Last Name:BHARATIYA
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 1:225 WILLIAMSON ST
Mailing Address - Street 2:PHYSICIAN BILLING
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3625
Mailing Address - Country:US
Mailing Address - Phone:908-994-8068
Mailing Address - Fax:
Practice Address - Street 1:655 E JERSEY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206-1259
Practice Address - Country:US
Practice Address - Phone:908-994-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA412782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2063409Medicaid
NJ2063409Medicaid
NJC55781Medicare UPIN