Provider Demographics
NPI:1790771228
Name:BHASKARA, JAYSHREE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYSHREE
Middle Name:
Last Name:BHASKARA
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 1:503 OMNI DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4528
Mailing Address - Country:US
Mailing Address - Phone:908-595-1199
Mailing Address - Fax:908-595-1410
Practice Address - Street 1:503 OMNI DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4528
Practice Address - Country:US
Practice Address - Phone:908-595-1199
Practice Address - Fax:908-595-1410
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08290100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG71414Medicare UPIN
NJ117121QC8Medicare PIN