MEDICARE: DR. RANJIT BHAGWAT PH.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	103TC0700X	Clinical Psychologist	020594	NY

General Provider Information

NPI Number	:	1770990251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANJIT BHAGWAT PH.D.

Provider Business Mailing Address
First Line	:	5 COMPUTER DR W STE 100-07
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-1613
Country	:	US
Telephone Number	:	518-309-2185
Fax Number	:	518-245-9180

Provider Business Practice Location Address
First Line	:	5 COMPUTER DR W STE 100-07
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-1613
Country	:	US
Telephone Number	:	518-309-2185
Fax Number	:	518-245-9180

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

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	07/07/2023

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