Healthcare Provider Details

I. General information

NPI: 1932115565
Provider Name (Legal Business Name): NEW YORK NEUROSCIENCE INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4256 BRONX BLVD STE 5
BRONX NY
10466-2672
US

IV. Provider business mailing address

4256 BRONX BLVD STE 5
BRONX NY
10466-2672
US

V. Phone/Fax

Practice location:
  • Phone: 718-655-9111
  • Fax: 718-231-1522
Mailing address:
  • Phone: 718-655-9111
  • Fax: 718-231-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KAMRAN TABADDOR
Title or Position: OWNER
Credential: MD
Phone: 718-655-9111