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General NPI Number Information
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NPI Number | 1093110488
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Entity Type | Individual
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Provider Name | DR. DIPANSH ATULBHAI BHAVSAR
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Gender | Male
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 16 E PROSPECT ST
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City | WALDWICK
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State | NJ
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Zip | 07463-2008
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Country | US
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Telephone | 201-445-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 36 SPRUCE ST
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City | JERSEY CITY
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State | NJ
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Zip | 07306-3521
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Country | US
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Telephone | 201-736-3689
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI03674800
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License Number State | NJ
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