Healthcare Provider Details

I. General information

NPI: 1306800057
Provider Name (Legal Business Name): REGIONAL NEUROLOGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 BRONX BLVD FRNT 1
BRONX NY
10466-2669
US

IV. Provider business mailing address

4234-1 BRONX BOULEVARD
BRONX NY
10466-2801
US

V. Phone/Fax

Practice location:
  • Phone: 718-515-4347
  • Fax: 718-653-8641
Mailing address:
  • Phone: 718-515-4347
  • Fax: 718-653-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number195905
License Number StateNY

VIII. Authorized Official

Name: DR. KAMRAN TABADDOR
Title or Position: PRESIDENT
Credential: MD
Phone: 718-655-9111