Provider Demographics
NPI:1760928014
Name:BHARATI D PENUPATRUNI MD LLC
Entity Type:Organization
Organization Name:BHARATI D PENUPATRUNI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BHARATI
Authorized Official - Middle Name:D
Authorized Official - Last Name:PENUPATRUNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-307-5695
Mailing Address - Street 1:4 DRINKING BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JCT
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 DRINKING BROOK RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH JCT
Practice Address - State:NJ
Practice Address - Zip Code:08852-2800
Practice Address - Country:US
Practice Address - Phone:908-307-5695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05220800208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty