Healthcare Provider Details

I. General information

NPI: 1821549783
Provider Name (Legal Business Name): IBRAHIM Y RABADI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 S JEFFERSON AVE
CATSKILL NY
12414-2109
US

IV. Provider business mailing address

35 S JEFFERSON AVE
CATSKILL NY
12414-2109
US

V. Phone/Fax

Practice location:
  • Phone: 518-943-3844
  • Fax:
Mailing address:
  • Phone: 518-943-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: IBRAHIM Y RABADI
Title or Position: OWNER
Credential: MD
Phone: 518-943-3844