Provider Demographics
NPI:1104977750
Name:BHATT, MIHIR (MD)
Entity type:Individual
Prefix:DR
First Name:MIHIR
Middle Name:
Last Name:BHATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LYLE PL
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4433
Mailing Address - Country:US
Mailing Address - Phone:908-769-5222
Mailing Address - Fax:908-769-1555
Practice Address - Street 1:456 ARLENE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3814
Practice Address - Country:US
Practice Address - Phone:201-694-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200246208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07986Medicare PIN
NY4H147DW092Medicare PIN
NY4H1471Medicare PIN
NYG400000547Medicare PIN
H14007Medicare UPIN
NYA400000993Medicare PIN