Provider Demographics
NPI:1295876712
Name:BHARAT, IVOR BERNARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:IVOR
Middle Name:BERNARD
Last Name:BHARAT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2140 E TREMONT AVE APT 5A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5707
Mailing Address - Country:US
Mailing Address - Phone:718-892-7528
Mailing Address - Fax:
Practice Address - Street 1:215 W 125TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4426
Practice Address - Country:US
Practice Address - Phone:212-939-3566
Practice Address - Fax:212-939-1434
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005744-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant