1669429528 NPI number — ISHALI BHATIA DPM

Table of content: ISHALI BHATIA DPM (NPI 1669429528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669429528 NPI number — ISHALI BHATIA DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHATIA
Provider First Name:
ISHALI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

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:
1669429528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 LINDEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14625-2716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-385-9030
Provider Business Mailing Address Fax Number:
585-385-9124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1561 LONG POND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14626-4117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-723-0030
Provider Business Practice Location Address Fax Number:
585-723-8478
Provider Enumeration Date:
05/27/2006

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: 213E00000X , with the licence number:  N005907 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 181267EQ . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02583255 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0119002 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2285734 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010005907 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010005907 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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