Provider Demographics
NPI:1962951293
Name:DR. JAY BHUTA PC
Entity type:Organization
Organization Name:DR. JAY BHUTA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BHUTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-532-3668
Mailing Address - Street 1:43 PINE BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1212
Mailing Address - Country:US
Mailing Address - Phone:973-525-3129
Mailing Address - Fax:973-994-1970
Practice Address - Street 1:225 MILLBURN AVE STE 104B
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1712
Practice Address - Country:US
Practice Address - Phone:732-532-3668
Practice Address - Fax:973-577-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00325500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty