Healthcare Provider Details

I. General information

NPI: 1619989639
Provider Name (Legal Business Name): ATUL BHASIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W MAIN ST STE A
FREEHOLD NJ
07728-2579
US

IV. Provider business mailing address

8 BARCLAY ST
MORGANVILLE NJ
07751-1005
US

V. Phone/Fax

Practice location:
  • Phone: 732-637-8444
  • Fax: 732-637-8440
Mailing address:
  • Phone: 732-637-8444
  • Fax: 732-637-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08006600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number25MA08006600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: