Provider Demographics
NPI:1013000538
Name:BHATIA, RAJA S (DO)
Entity type:Individual
Prefix:DR
First Name:RAJA
Middle Name:S
Last Name:BHATIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2346
Mailing Address - Country:US
Mailing Address - Phone:718-979-4948
Mailing Address - Fax:718-650-0084
Practice Address - Street 1:2334 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2346
Practice Address - Country:US
Practice Address - Phone:718-979-4948
Practice Address - Fax:718-650-0084
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70V521Medicare ID - Type Unspecified
NY85957Medicare UPIN