Female

Mira R. Brahmbhatt PA-C

Physician Assistant in West Caldwell, NJ(View on Map)

Full Name

Mira Raju Brahmbhatt PA-C

NPI Number

1891348165

NPI Type

Individual Provider

Gender

Female

Enumeration Date

07/16/2019

Specialties

(Taxonomies)

Code

363A00000X
207R00000X

Primary Taxonomy

Yes
No

Licenses

State

California
New Jersey
Texas
Texas

License Number

65059
25MP00524400
PA14849
PATEMP

Contact
Information

Purpose

Mailing
Location

Address

69 HAGGERTY DR
1129 BLOOMFIELD AVE

City

West Orange
West Caldwell

State

NJ
NJ

Postal Code

07052-1437
07006-7127

Country

US
US

Telephone Number

N/A
(973) 500-2686

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 10/01/2024

Provider Address

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