Healthcare Provider Details

I. General information

NPI: 1760928014
Provider Name (Legal Business Name): BHARATI D PENUPATRUNI MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DRINKING BROOK RD
MONMOUTH JCT NJ
08852-2800
US

IV. Provider business mailing address

4 DRINKING BROOK RD
MONMOUTH JCT NJ
08852-2800
US

V. Phone/Fax

Practice location:
  • Phone: 908-307-5695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA05220800
License Number StateNJ

VIII. Authorized Official

Name: BHARATI D PENUPATRUNI
Title or Position: OWNER
Credential:
Phone: 908-307-5695