MEDICARE: DR. JYOTSNA BHATTACHARYA 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	390200000X	Student in an Organized Health Care Education/Training Program		NY
2	208000000X	Pediatrics Physician	263165	NY

General Provider Information

NPI Number	:	1477842938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JYOTSNA BHATTACHARYA M.D.

Provider Business Mailing Address
First Line	:	4800 SAND POINT WAY NE,
Second Line	:	M/S MA. 7.110, PO BOX 5371
City	:	SEATTLE
State	:	WA
Zip	:	98105-5005
Country	:	US
Telephone Number	:	773-320-9969
Fax Number	:	206-987-5060

Provider Business Practice Location Address
First Line	:	201 50TH AVE APT 17M
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5776
Country	:	US
Telephone Number	:	773-320-9969
Fax Number	:

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

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	11/17/2015

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