Provider Demographics
NPI:1669405833
Name:BHUYAN, RUPREKHA (MD)
Entity type:Individual
Prefix:
First Name:RUPREKHA
Middle Name:
Last Name:BHUYAN
Suffix:
Gender:F
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:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-6086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6010 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9752
Practice Address - Country:US
Practice Address - Phone:609-646-5142
Practice Address - Fax:609-646-8715
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA050605002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3977307Medicaid
NJ732133CB8Medicare PIN
NJ732133CN9Medicare PIN
NJ3977307Medicaid