Healthcare Provider Details

I. General information

NPI: 1104977750
Provider Name (Legal Business Name): MIHIR BHATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 ARLENE ST
STATEN ISLAND NY
10314-3814
US

IV. Provider business mailing address

22 LYLE PL
EDISON NJ
08820-4433
US

V. Phone/Fax

Practice location:
  • Phone: 201-694-6052
  • Fax:
Mailing address:
  • Phone: 908-769-5222
  • Fax: 908-769-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number200246
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: