Provider Demographics
NPI:1942741244
Name:BHARDWAJ, SURAJ
Entity Type:Individual
Prefix:
First Name:SURAJ
Middle Name:
Last Name:BHARDWAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 SW 152 TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-9805
Mailing Address - Country:US
Mailing Address - Phone:954-682-8517
Mailing Address - Fax:
Practice Address - Street 1:1599 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-9000
Practice Address - Country:US
Practice Address - Phone:561-338-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9110075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant