Provider Demographics
NPI:1104908904
Name:BHATTACHARYYA, JAYATI C (DDS)
Entity type:Individual
Prefix:DR
First Name:JAYATI
Middle Name:C
Last Name:BHATTACHARYYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:2600 NETHERLAND AVE
Mailing Address - Street 2:APT. 1221
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4801
Mailing Address - Country:US
Mailing Address - Phone:718-543-2962
Mailing Address - Fax:718-543-2962
Practice Address - Street 1:1516 JARRET PL
Practice Address - Street 2:SUITE 100
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2607
Practice Address - Country:US
Practice Address - Phone:718-405-8194
Practice Address - Fax:718-405-8049
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0513581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51358Medicaid