Basic Information
| Provider Information | |||||||||
| NPI: | 1427081736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHARUCHA | ||||||||
| FirstName: | DILIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22581 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100872581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566696050 | ||||||||
| FaxNumber: | 8565283117 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 AUER COURT | ||||||||
| Address2: | SUITE #B | ||||||||
| City: | EAST BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088165827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326514142 | ||||||||
| FaxNumber: | 7326515950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 10/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | MA44151 | NJ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | 0725005 | 05 | NJ | MEDICAID |