Healthcare Provider Details

I. General information

NPI: 1063687812
Provider Name (Legal Business Name): ANUJ BHARDWAJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 ASTOR AVE MONTEFIORE MEDICAL GROUP-2ND FLOOR
BRONX NY
10469-5900
US

IV. Provider business mailing address

1500 ASTOR AVE MONTEFIORE MEDICAL GROUP-2ND FLOOR
BRONX NY
10469-5900
US

V. Phone/Fax

Practice location:
  • Phone: 718-881-0100
  • Fax: 718-881-7752
Mailing address:
  • Phone: 718-881-0100
  • Fax: 718-881-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number248366
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: