Healthcare Provider Details

I. General information

NPI: 1891881686
Provider Name (Legal Business Name): PRIYADARSHINI ANIL BHATE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE BRONX LEBANON HOSPITAL CENTER
BRONX NY
10457
US

IV. Provider business mailing address

107 LORING AVE
EDISON NJ
08817-4305
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-5083
  • Fax: 718-518-5079
Mailing address:
  • Phone: 732-393-9192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number210737
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: