Provider Demographics
NPI:1851393870
Name:BHATTACHARYYA, BHASKAR (DPM)
Entity Type:Individual
Prefix:
First Name:BHASKAR
Middle Name:
Last Name:BHATTACHARYYA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-213-0348
Practice Address - Street 1:1404 PORTLAND AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3016
Practice Address - Country:US
Practice Address - Phone:585-266-1940
Practice Address - Fax:585-266-2223
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005831-3213ES0131X
NY005831213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02360167Medicaid
NYDD2042Medicare PIN
NY02360167Medicaid