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General NPI Number Information
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NPI Number | 1104908904
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Entity Type | Individual
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Provider Name | JAYATI C BHATTACHARYYA DDS
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Gender | Female
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1516 JARRET PL SUITE 100
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City | BRONX
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State | NY
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Zip | 10461-2607
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Country | US
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Telephone | 718-405-8194
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Fax | 718-405-8049
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Provider Business Mailing Address
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Address Line | 2600 NETHERLAND AVE APT. 1221
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City | BRONX
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State | NY
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Zip | 10463-4801
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Country | US
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Telephone | 718-543-2962
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Fax | 718-543-2962
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 051358
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License Number State | NY
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