Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25MA07822300 | NJ |
Y | 111NI0900X | Internist | 25MA07822300 | NJ |
N | 207RG0300X | Geriatric Medicine | 25MA07822300 | NJ |
NPI | 1043261746 |
---|---|
Provider Name | Mrs. Bhavana Rebba |
First Address | Piscataway, NJ 08854-6270 |
Second Address | Edison, NJ 08837-3266 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 09/06/2015 |