Basic Information
| Provider Information | |||||||||
| NPI: | 1942244405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHATIA | ||||||||
| FirstName: | SANJAY | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1411 WOODBOURNE RD | ||||||||
| Address2: | |||||||||
| City: | LEVITTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190571540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159432000 | ||||||||
| FaxNumber: | 2159434439 | ||||||||
| Practice Location | |||||||||
| Address1: | 1411 WOODBOURNE RD | ||||||||
| Address2: | |||||||||
| City: | LEVITTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190571540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159432000 | ||||||||
| FaxNumber: | 2159434439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 09/27/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA08035100 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD431016 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00426189 | 01 | VT | RAIL ROAD MEDICARE | OTHER | P00427721 | 01 | MO | RAIL ROAD MEDICARE | OTHER | P00765921 | 01 | PA | RR MEDICARE | OTHER | P00795382 | 01 | PA | RR MEDICARE- LOWER BUCKS | OTHER | 30060275 | 01 | PA | KEYSTONE MERCY-LOWER BUCKS GROUP | OTHER | P00399305 | 01 | NJ | RAIL ROAD MEDICARE | OTHER | 302336 | 05 | SC | MEDICAID | 0101451 | 05 | NJ | MEDICAID | 1014200 | 05 | VT | MEDICAID | 101934640 0002 | 05 | PA | MEDICAID | 30061936 | 01 | PA | KEYSTONE MERCY | OTHER |