MEDICARE: DR. JODUMUTT G. BHAT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	122149	NY

General Provider Information

NPI Number	:	1356390603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODUMUTT G. BHAT MD

Provider Business Mailing Address
First Line	:	2314 COLLEGE POINT BLVD
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2526
Country	:	US
Telephone Number	:	347-312-3041
Fax Number	:	718-661-1556

Provider Business Practice Location Address
First Line	:	6971 GRAND AVE
Second Line	:
City	:	MASPETH
State	:	NY
Zip	:	11378-1825
Country	:	US
Telephone Number	:	718-507-4400
Fax Number	:	718-507-2484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	07/08/2007

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