MEDICARE: DR. GAURANG RAVAJI BRAHMBHATT M.D.

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	207Q00000X	Family Medicine Physician	25MA07706800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225204266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAURANG RAVAJI BRAHMBHATT M.D.

Provider Business Mailing Address
First Line	:	609 WASHINGTON ST
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-4907
Country	:	US
Telephone Number	:	201-706-8490
Fax Number	:	201-706-8491

Provider Business Practice Location Address
First Line	:	609 WASHINGTON ST
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-4907
Country	:	US
Telephone Number	:	201-706-8490
Fax Number	:	201-706-8491

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

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	07/30/2013

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