Provider Demographics
NPI:1154043024
Name:TIWARI, BHARAT (AGNP-BC)
Entity type:Individual
Prefix:MR
First Name:BHARAT
Middle Name:
Last Name:TIWARI
Suffix:
Gender:M
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11619 INWOOD ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1349
Mailing Address - Country:US
Mailing Address - Phone:914-819-8315
Mailing Address - Fax:
Practice Address - Street 1:1250 WATERS PLACE TOWER 1 10TH FLOOR
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:347-577-4484
Practice Address - Fax:929-246-6376
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310871363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty