Basic Information
| Provider Information | |||||||||
| NPI: | 1700047594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHISE | ||||||||
| FirstName: | VIKRAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 89 FRENCH ST FL 2 | ||||||||
| Address2: | CHILDREN'S HEALTH INSTITUTE OF NEW JERSEY | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322357875 | ||||||||
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| Practice Location | |||||||||
| Address1: | 89 FRENCH ST FL 2 | ||||||||
| Address2: | CHILDREN'S HEALTH INSTITUTE OF NEW JERSEY | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322357875 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2008 | ||||||||
| LastUpdateDate: | 02/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0402X | 248987 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | 2084N0600X | 243554 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | 2084N0402X | 25MA08772500 | NJ | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | 2084N0600X | 25MA08772500 | NJ | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology |
ID Information
| ID | Type | State | Issuer | Description | 0244295 | 05 | NJ | MEDICAID |