Provider Demographics
NPI:1295160026
Name:A.K. BHATTACHARYA,MD,LLC
Entity type:Organization
Organization Name:A.K. BHATTACHARYA,MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:K
Authorized Official - Last Name:BHATTACHARYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-683-1033
Mailing Address - Street 1:55 SCHANCK RD
Mailing Address - Street 2:A-4
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2964
Mailing Address - Country:US
Mailing Address - Phone:732-683-1033
Mailing Address - Fax:732-683-2477
Practice Address - Street 1:55 SCHANCK RD
Practice Address - Street 2:A-4
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2964
Practice Address - Country:US
Practice Address - Phone:732-683-1033
Practice Address - Fax:732-683-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA057831174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467427807OtherINDIVIDUAL NPI
G51120Medicare UPIN