Provider Demographics
NPI:1679763890
Name:BHANDARI, BHAVIK MUKESH (MD)
Entity Type:Individual
Prefix:
First Name:BHAVIK
Middle Name:MUKESH
Last Name:BHANDARI
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 1:466 OLD HOOK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1368
Mailing Address - Country:US
Mailing Address - Phone:201-967-8221
Mailing Address - Fax:
Practice Address - Street 1:466 OLD HOOK RD STE 1
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1368
Practice Address - Country:US
Practice Address - Phone:201-967-8221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08267100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0155349Medicaid
NJ0155349Medicaid
NJ121858XPFMedicare PIN