Provider Demographics
NPI:1679507347
Name:BHATNAGAR, VIBHAY (MD)
Entity Type:Individual
Prefix:
First Name:VIBHAY
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 1:32N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1429
Mailing Address - Country:US
Mailing Address - Phone:732-462-4100
Mailing Address - Fax:732-462-4549
Practice Address - Street 1:530 GREEN STREET
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830
Practice Address - Country:US
Practice Address - Phone:732-283-0440
Practice Address - Fax:732-283-8943
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1712705Medicaid
NJ474813Medicare PIN
NJC56395Medicare UPIN