Provider Demographics
NPI:1801059019
Name:BHAVINI S CHANDARANA MD LLC
Entity type:Organization
Organization Name:BHAVINI S CHANDARANA MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BHAVINI
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANDARANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-414-6499
Mailing Address - Street 1:420 ROUTE 34
Mailing Address - Street 2:SUITE 317
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722
Mailing Address - Country:US
Mailing Address - Phone:732-414-6499
Mailing Address - Fax:732-510-0616
Practice Address - Street 1:420 RT 34
Practice Address - Street 2:SUITE 317
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722
Practice Address - Country:US
Practice Address - Phone:732-414-6499
Practice Address - Fax:732-510-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0089214Medicaid
NJ648846001OtherDME PTAN