Provider Demographics
NPI:1124289236
Name:BMB MEDICAL PC
Entity type:Organization
Organization Name:BMB MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIHIR
Authorized Official - Middle Name:J
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-694-6052
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:201-694-6052
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:908-769-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2002462081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100000051Medicare PIN
NYA100000136Medicare PIN