Provider Demographics
NPI:1841212800
Name:BYAHATTI, PRAMILA (MD)
Entity Type:Individual
Prefix:MRS
First Name:PRAMILA
Middle Name:
Last Name:BYAHATTI
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 1:1907 PARK AVE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080
Mailing Address - Country:US
Mailing Address - Phone:908-756-2080
Mailing Address - Fax:908-668-0455
Practice Address - Street 1:1907 PARK AVE
Practice Address - Street 2:SUITE #103
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080
Practice Address - Country:US
Practice Address - Phone:908-756-2080
Practice Address - Fax:908-668-0455
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA030896207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1389602Medicaid
F68748Medicare UPIN
NJ1389602Medicaid