Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 25MA08758600 | NJ |
Y | 2086S0127X | Trauma Surgeon | 25MA08758600 | NJ |
NPI | 1073816351 |
---|---|
Provider Name | Ravikumar B Brahmbhatt |
First Address | Edison, NJ 08820-3653 |
Second Address | Jersey City, NJ 07302-4321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2010 |
Last Update Date | 28/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D09771800 | CDS( CONTROLLED DANGEROUS SUBSTANCE) (01) | NJ |