Healthcare Provider Details

I. General information

NPI: 1710300421
Provider Name (Legal Business Name): SUBBARAO BHIMANI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 OLD COUNTRY RD STE C STE 284
PLAINVIEW NY
11803-4936
US

IV. Provider business mailing address

998 OLD COUNTRY RD STE C STE 284
PLAINVIEW NY
11803-4936
US

V. Phone/Fax

Practice location:
  • Phone: 631-465-9333
  • Fax: 631-465-9333
Mailing address:
  • Phone: 631-465-9333
  • Fax: 631-465-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number237173
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DIANE D'ANGELO
Title or Position: BILLING MGR
Credential:
Phone: 631-465-9333