Provider Demographics
NPI:1588902837
Name:BRAHMBHATT, SWATI (PA-C)
Entity type:Individual
Prefix:
First Name:SWATI
Middle Name:
Last Name:BRAHMBHATT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1429
Mailing Address - Country:US
Mailing Address - Phone:201-457-2300
Mailing Address - Fax:201-457-1715
Practice Address - Street 1:331 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1429
Practice Address - Country:US
Practice Address - Phone:201-457-2300
Practice Address - Fax:201-457-1715
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00292000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant