Provider Demographics
NPI:1750539060
Name:HARCHARAN K BHATIA MD PC
Entity type:Organization
Organization Name:HARCHARAN K BHATIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIEJO
Authorized Official - Middle Name:
Authorized Official - Last Name:OMEDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-271-9151
Mailing Address - Street 1:95 BROADHOLLOW RD
Mailing Address - Street 2:STE.204
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2506
Mailing Address - Country:US
Mailing Address - Phone:631-271-9151
Mailing Address - Fax:631-271-9155
Practice Address - Street 1:175 JERICHO TPKE
Practice Address - Street 2:STE.204
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4532
Practice Address - Country:US
Practice Address - Phone:516-802-2865
Practice Address - Fax:516-496-4393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00492902Medicaid
NY24A151Medicare PIN
NY00492902Medicaid