Provider Demographics
NPI:1689621849
Name:BHASKARABHATLA, KRISHNA VENKATA MURALI (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:VENKATA MURALI
Last Name:BHASKARABHATLA
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 1:1031 MCBRIDE AVE
Mailing Address - Street 2:SUITE D 208
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2559
Mailing Address - Country:US
Mailing Address - Phone:973-790-3111
Mailing Address - Fax:973-272-1123
Practice Address - Street 1:1031 MCBRIDE AVE
Practice Address - Street 2:SUITE D 208
Practice Address - City:WEST PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07424-2559
Practice Address - Country:US
Practice Address - Phone:973-790-3111
Practice Address - Fax:973-272-1123
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2009-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07455000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine