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General NPI Number Information
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NPI Number | 1558710715
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Entity Type | Organization
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Legal Business Name | RIDGEWOOD BUSHWICK NEPHROLOGY ASSOCIATES,PLLC
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 385 SENECA AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-1340
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Country | US
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Telephone | 718-408-6200
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Fax | 718-821-2956
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Provider Business Mailing Address
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Address Line | 385 SENECA AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-1340
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Country | US
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Telephone | 718-408-6200
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Fax | 718-821-2956
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. PREMILA BHAT
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Credential | MD
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Telephone | 917-837-8097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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