Provider Demographics
NPI:1679648828
Name:IRANI, BAKHTAVER (MD)
Entity Type:Individual
Prefix:DR
First Name:BAKHTAVER
Middle Name:
Last Name:IRANI
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 1:21 E PARK PL
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2313
Mailing Address - Country:US
Mailing Address - Phone:201-896-9223
Mailing Address - Fax:201-896-0641
Practice Address - Street 1:21 E PARK PL
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2313
Practice Address - Country:US
Practice Address - Phone:201-896-9223
Practice Address - Fax:201-896-0641
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02617000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJIR482476Medicare ID - Type Unspecified
NJD92561Medicare UPIN