Healthcare Provider Details

I. General information

NPI: 1780956219
Provider Name (Legal Business Name): BHARATHI NAYAK M.D.P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 S HARRISON ST SUITE # 101
EAST ORANGE NJ
07018-1700
US

IV. Provider business mailing address

22 WINDING WAY
WOODLAND PARK NJ
07424-2665
US

V. Phone/Fax

Practice location:
  • Phone: 973-672-2005
  • Fax: 973-672-2940
Mailing address:
  • Phone: 973-672-2005
  • Fax: 973-672-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number25MA03013500
License Number StateNJ

VIII. Authorized Official

Name: DR. BHARATHI NAYAK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 973-672-2005