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General NPI Number Information
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NPI Number | 1912098690
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Entity Type | Individual
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Provider Name | BHARATHI NAYAK M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 85 S HARRISON ST SUITE # 101
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City | EAST ORANGE
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State | NJ
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Zip | 07018-1700
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Country | US
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Telephone | 973-672-2005
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Fax | 973-672-2940
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Provider Business Mailing Address
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Address Line | 22 WINDING WAY
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-2665
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Country | US
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Telephone | 973-672-2005
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Fax | 973-672-2940
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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 | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | MA30135
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License Number State | NJ
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