Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MA10865300 | NJ |
N | 111NI0900X | Internist | 25MA10865300 | NJ |
Y | 207RI0011X | Interventional Cardiology | 25MA10865300 | NJ |
NPI | 1083059158 |
---|---|
Provider Name | Dr. Kunal Brahmbhatt |
First Address | Passaic, NJ 07055-5803 |
Second Address | Passaic, NJ 07055-5803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2013 |
Last Update Date | 21/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA10865300 | STATE LICENSE (01) | NJ |