Healthcare Provider Details

I. General information

NPI: 1356341473
Provider Name (Legal Business Name): BHARAT J JHAVERI, MD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 04/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E JIMMIE LEEDS RD UNIT 702
GALLOWAY NJ
08205-4124
US

IV. Provider business mailing address

502 E BRADFORD AVE
GALLOWAY NJ
08205
US

V. Phone/Fax

Practice location:
  • Phone: 609-484-7009
  • Fax: 609-484-7571
Mailing address:
  • Phone: 609-652-8593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA03576100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: