Provider Demographics
NPI:1669429528
Name:BHATIA, ISHALI (DPM)
Entity type:Individual
Prefix:
First Name:ISHALI
Middle Name:
Last Name:BHATIA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2716
Mailing Address - Country:US
Mailing Address - Phone:585-385-9030
Mailing Address - Fax:585-385-9124
Practice Address - Street 1:1561 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4117
Practice Address - Country:US
Practice Address - Phone:585-723-0030
Practice Address - Fax:585-723-8478
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005907213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY181267EQOtherPREFERRED CARE
NY02583255Medicaid
0119002OtherGHI
2285734OtherUNITED HEALTHCARE
NYP010005907OtherBLUE CHOICE
NYP010005907OtherBLUE SHIELD
NY181267EQOtherPREFERRED CARE
NYP010005907OtherBLUE SHIELD
NYP010005907OtherBLUE CHOICE