Basic Information
Provider Information
NPI: 1801375993
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHASIN
FirstName: POOJA GOGIA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 240 EASTON AVENUE
Address2: 4TH FLOOR CARES, RM 4014
City: NEW BRUNSWICK
State: NJ
PostalCode: 08901
CountryCode: US
TelephoneNumber: 7327458600
FaxNumber:  
Practice Location
Address1: 240 EASTON AVENUE
Address2: 4TH FLOOR CARES, RM 4014
City: NEW BRUNSWICK
State: NJ
PostalCode: 08901
CountryCode: US
TelephoneNumber: 7327458600
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/09/2018
LastUpdateDate: 08/09/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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