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General NPI Number Information
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NPI Number | 1699071514
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Entity Type | Organization
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Legal Business Name | DR. SUSHEEL BATHLA
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Dates
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Enumeration Date | 02/10/2011
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 172 DEER RUN
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City | WATCHUNG
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State | NJ
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Zip | 07069-6222
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Country | US
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Telephone | 917-826-5709
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Fax |
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Provider Business Mailing Address
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Address Line | 172 DEER RUN
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City | WATCHUNG
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State | NJ
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Zip | 07069-6222
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Country | US
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Telephone | 917-826-5709
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Fax |
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Authorized Official
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Title or Position | PODIATRIST/OWNER
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Name | DR. SUSHEEL BATHLA
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Credential | DPM
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Telephone | 917-826-5709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 25MD00304500
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License Number State | NJ
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