Healthcare Provider Details

I. General information

NPI: 1154043024
Provider Name (Legal Business Name): BHARAT TIWARI AGNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATERS PLACE TOWER 1 10TH FLOOR
BRONX NY
10461
US

IV. Provider business mailing address

11619 INWOOD ST
JAMAICA NY
11436-1349
US

V. Phone/Fax

Practice location:
  • Phone: 347-577-4484
  • Fax: 929-246-6376
Mailing address:
  • Phone: 914-819-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: