Provider Demographics
NPI:1356341473
Name:JHAVERI, MD, BHARAT J (MD)
Entity type:Individual
Prefix:
First Name:BHARAT
Middle Name:J
Last Name:JHAVERI, MD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 E BRADFORD AVE
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205
Mailing Address - Country:US
Mailing Address - Phone:609-652-8593
Mailing Address - Fax:
Practice Address - Street 1:319 E JIMMIE LEEDS RD UNIT 702
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4124
Practice Address - Country:US
Practice Address - Phone:609-484-7009
Practice Address - Fax:609-484-7571
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03576100208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
220030377OtherRAILROAD MEDICARE
NJ2420805Medicaid
NJ457265CXLMedicare PIN
NJ2420805Medicaid