Healthcare Provider Details

I. General information

NPI: 1124289236
Provider Name (Legal Business Name): BMB MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
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: 908-769-1555
Mailing address:
  • Phone: 201-694-6052
  • Fax: 908-769-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number200246
License Number StateNY

VIII. Authorized Official

Name: MIHIR J BHATT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-694-6052