1386783686 NPI number — MR. ABDEL RAHMAN SAYED BAKHATY MD

Table of content: MR. ABDEL RAHMAN SAYED BAKHATY MD (NPI 1386783686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386783686 NPI number — MR. ABDEL RAHMAN SAYED BAKHATY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKHATY
Provider First Name:
ABDEL RAHMAN
Provider Middle Name:
SAYED
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386783686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3485
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SECAUNCUS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-217-6822
Provider Business Mailing Address Fax Number:
201-217-6899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 KENNEDY BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07306-3416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-217-6822
Provider Business Practice Location Address Fax Number:
201-217-6899
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  MA 042237 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: J018597 . This is a "TRICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2751747 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0724807 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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