1164482782 NPI number — NIKHIL BHARDWAJ MD

Table of content: NIKHIL BHARDWAJ MD (NPI 1164482782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164482782 NPI number — NIKHIL BHARDWAJ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHARDWAJ
Provider First Name:
NIKHIL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164482782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1636 NE 194TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33179-6449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-792-7566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21355 E DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33180-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-932-2552
Provider Business Practice Location Address Fax Number:
305-932-2503
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME 79930 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: ME79930 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: ME79930 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N191965 . This is a "PREFERRED CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: H12007 . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: UNITED HEALTH . This is a "4800593" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7469122 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 261864800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: N191965 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273491 . This is a "AV MED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 35713 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N191965 . This is a "STAYWELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 39509 . This is a "NEIGHBORHOOD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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