Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 25MA0669860 | NJ |
NPI | 1003854092 |
---|---|
Provider Name | Nishith Bhattacharyya |
First Address | Philadelphia, PA 19178 |
Second Address | Maplewood, NJ 07040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 21/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7558406 | (05) | NJ |
G66800 | (02) |