Provider Demographics
NPI:1013959386
Name:PUJAN GASTROENTEROLOGIST, PLLC
Entity Type:Organization
Organization Name:PUJAN GASTROENTEROLOGIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BHAVNA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BALAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-568-1243
Mailing Address - Street 1:161 TRUMAN DR
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-1709
Mailing Address - Country:US
Mailing Address - Phone:201-568-1243
Mailing Address - Fax:
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:DIVISION OF GASTROENTEROLOGY, 3RD FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-518-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219532207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02459781Medicaid
I00782Medicare UPIN
NY203AZ1Medicare ID - Type Unspecified