Provider Demographics
NPI:1912098690
Name:NAYAK, BHARATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARATHI
Middle Name:
Last Name:NAYAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2665
Mailing Address - Country:US
Mailing Address - Phone:973-672-2005
Mailing Address - Fax:973-672-2940
Practice Address - Street 1:85 S HARRISON ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1700
Practice Address - Country:US
Practice Address - Phone:973-672-2005
Practice Address - Fax:973-672-2940
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA30135204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222499217OtherTAX ID
NJ3160203Medicaid
NJC56822Medicare UPIN
NJ222499217OtherTAX ID