Provider Demographics
NPI:1801905690
Name:JOYDIP BHATTACHARYA, D.O., MEDICAL CORPORATION
Entity type:Organization
Organization Name:JOYDIP BHATTACHARYA, D.O., MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYDIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATTACHARYA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:831-454-0599
Mailing Address - Street 1:1575 SOQUEL DR # B
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1700
Mailing Address - Country:US
Mailing Address - Phone:831-454-0599
Mailing Address - Fax:831-454-9157
Practice Address - Street 1:1575 SOQUEL DR # B
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1700
Practice Address - Country:US
Practice Address - Phone:831-454-0599
Practice Address - Fax:831-454-9157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084N0600X
CA20A87732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX87730Medicaid
ZZZ03961ZMedicare PIN
105297Medicare UPIN
P00305379Medicare PIN