Healthcare Provider Details

I. General information

NPI: 1578665048
Provider Name (Legal Business Name): OPTUM MEDICAL CARE OF NEW JERSEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DAKOTA DR
NEW HYDE PARK NY
11042-1135
US

IV. Provider business mailing address

1 DAKOTA DR
NEW HYDE PARK NY
11042-1135
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-1811
  • Fax: 516-627-1315
Mailing address:
  • Phone: 516-627-1811
  • Fax: 516-627-1315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08407900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA03363500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNJ

VIII. Authorized Official

Name: GAURANG BRAHMBHATT
Title or Position: VP GENERAL MANAGEMENT
Credential: MD
Phone: 201-706-8490