Healthcare Provider Details

I. General information

NPI: 1134857253
Provider Name (Legal Business Name): VARUN BHATIA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 DURHAM AVE
SOUTH PLAINFIELD NJ
07080-2309
US

IV. Provider business mailing address

2633 EDWARD STEC BLVD
EDISON NJ
08837-7011
US

V. Phone/Fax

Practice location:
  • Phone: 201-693-5373
  • Fax: 425-940-0505
Mailing address:
  • Phone: 201-693-5373
  • Fax: 425-940-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: VARUN BHATIA
Title or Position: AUTHORIZED OFFICAL
Credential: MD
Phone: 201-693-5373