Provider Demographics
NPI:1366704306
Name:SRIVASTAVA, BHARTI
Entity type:Individual
Prefix:
First Name:BHARTI
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14467 41ST AVE
Mailing Address - Street 2:APT 628
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1400
Mailing Address - Country:US
Mailing Address - Phone:646-286-9781
Mailing Address - Fax:718-961-5608
Practice Address - Street 1:2 ROOSEVELT AVE
Practice Address - Street 2:SUITE NUMBER 300
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3064
Practice Address - Country:US
Practice Address - Phone:516-496-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16171171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator