MEDICARE: MR. JOHNSANJAY BHASKAR PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 40QA00909200	NJ

General Provider Information

NPI Number	:	1134329394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHNSANJAY BHASKAR PT

Provider Business Mailing Address
First Line	:	8 BULLOCK WAY
Second Line	:
City	:	CHESTERFIELD
State	:	NJ
Zip	:	08515-9742
Country	:	US
Telephone Number	:	732-790-2674
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 BULLOCK WAY
Second Line	:
City	:	CHESTERFIELD
State	:	NJ
Zip	:	08515-9742
Country	:	US
Telephone Number	:	732-790-2674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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