Healthcare Provider Details

I. General information

NPI: 1215469739
Provider Name (Legal Business Name): JANAK BHATT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

450 CLARKSON AVE SUNY DOWNSTATE
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA11114600
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number333681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: