1790717239 NPI number — DR. BDAIR M ABULAIMOUN III M.D.

Table of content: DR. BDAIR M ABULAIMOUN III M.D. (NPI 1790717239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790717239 NPI number — DR. BDAIR M ABULAIMOUN III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABULAIMOUN
Provider First Name:
BDAIR
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
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:
1790717239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 COMMUNITY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANHASETT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-348-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 COMUNITY DR
Provider Second Line Business Practice Location Address:
SCHNEIDER CHILD.HOSPITAL -3 LEVITT
Provider Business Practice Location Address City Name:
MANHASSETT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11030-2377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-558-0200
Provider Business Practice Location Address Fax Number:
516-562-4516
Provider Enumeration Date:
07/07/2006

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: 208000000X , with the licence number:  78125 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: 204007 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3164454 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J18033 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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