Provider Demographics
NPI:1679638209
Name:DUDANI, BHARTI (MD)
Entity Type:Individual
Prefix:MRS
First Name:BHARTI
Middle Name:
Last Name:DUDANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:GAYATRI
Other - Middle Name:BHARATI
Other - Last Name:DUDANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11141 77TH AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-793-2746
Mailing Address - Fax:800-807-6698
Practice Address - Street 1:11141 77TH AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-793-2746
Practice Address - Fax:800-807-6698
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236367208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02729257Medicaid