Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 242158 | NY |
NPI | 1003987496 |
---|---|
Provider Name | Madhu Bhaskaran |
First Address | Great Neck, NY 11021 |
Second Address | Great Neck, NY 11021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/07/2007 |