Healthcare Provider Details

I. General information

NPI: 1063856128
Provider Name (Legal Business Name): JAYATI C. BHATTACHARYYA DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N BEERS ST STE 3
HOLMDEL NJ
07733-1510
US

IV. Provider business mailing address

702 N BEERS ST STE 3
HOLMDEL NJ
07733-1510
US

V. Phone/Fax

Practice location:
  • Phone: 732-739-3535
  • Fax:
Mailing address:
  • Phone: 732-739-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number22D102331201
License Number StateNJ

VIII. Authorized Official

Name: DR. JAYATI C. BHATTACHARYYA
Title or Position: DOCTOR/OWNER
Credential: DDS
Phone: 732-739-3535