Healthcare Provider Details

I. General information

NPI: 1568680841
Provider Name (Legal Business Name): MADHURI BEWTRA, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405A SOUTH VAN BRUNT ST SUITE 405
ENGLEWOOD NJ
07646-4604
US

IV. Provider business mailing address

405A SOUTH VAN BRUNT ST SUITE 405
ENGLEWOOD NJ
07646-4604
US

V. Phone/Fax

Practice location:
  • Phone: 201-871-4346
  • Fax: 201-871-5953
Mailing address:
  • Phone: 201-871-4346
  • Fax: 201-871-5953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberH49244
License Number StateNJ

VIII. Authorized Official

Name: DR. MADHURI BEWTRA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 201-871-4346