Basic Information
| Provider Information | |||||||||
| NPI: | 1396760609 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHALODIA | ||||||||
| FirstName: | MANISH | ||||||||
| MiddleName: | VALLABHDAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 ROUTE 46 E STE 450 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070041583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735593700 | ||||||||
| FaxNumber: | 9735598650 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 BLOOMFIELD AVE | ||||||||
| Address2: | STE LL-1 | ||||||||
| City: | VERONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732334493 | ||||||||
| FaxNumber: | 9732334505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 06/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 25MA06543200 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 5746276 | 01 | NJ | CIGNA | OTHER | 00002162903 | 01 | NJ | UNITED HEALTHCARE | OTHER | 00002162903 | 01 | NJ | EMPIRE/UHC | OTHER | 60426946 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 8864831 | 01 | NJ | EMBLEM HEALTH | OTHER |