Provider Demographics
NPI:1740357730
Name:BAKHTAVER IRANI MD, PC
Entity type:Organization
Organization Name:BAKHTAVER IRANI MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BAKHTAVER
Authorized Official - Middle Name:
Authorized Official - Last Name:IRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-896-9223
Mailing Address - Street 1:21 E PARK PL
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2313
Mailing Address - Country:US
Mailing Address - Phone:201-896-9223
Mailing Address - Fax:201-896-0641
Practice Address - Street 1:21 E PARK PL
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2313
Practice Address - Country:US
Practice Address - Phone:201-896-9223
Practice Address - Fax:201-896-0641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty