Healthcare Provider Details

I. General information

NPI: 1578819652
Provider Name (Legal Business Name): BHARAT I NANDU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 JAMES ST
EDISON NJ
08820-3947
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 732-321-7189
  • Fax: 908-906-4929
Mailing address:
  • Phone: 800-994-0371
  • Fax: 254-215-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR6851
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA09693000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: