Provider Demographics
NPI:1972765683
Name:SHIV S. BHATT PHYSICIAN PC.
Entity type:Organization
Organization Name:SHIV S. BHATT PHYSICIAN PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIV
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-336-7499
Mailing Address - Street 1:1617 N JAMES ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2852
Mailing Address - Country:US
Mailing Address - Phone:315-336-7499
Mailing Address - Fax:315-336-3831
Practice Address - Street 1:1617 N JAMES ST
Practice Address - Street 2:SUITE 600
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2852
Practice Address - Country:US
Practice Address - Phone:315-336-7499
Practice Address - Fax:315-336-3831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146859-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1480OtherMEDICARE PTAN #
NYBA1480OtherMEDICARE PTAN #