Healthcare Provider Details

I. General information

NPI: 1063467546
Provider Name (Legal Business Name): KAMAL A TADROS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235-20 147 AVE STE 1
ROSEDALE NY
11422
US

IV. Provider business mailing address

235-20 147 AVE STE 1
ROSEDALE NY
11422
US

V. Phone/Fax

Practice location:
  • Phone: 718-276-1433
  • Fax:
Mailing address:
  • Phone: 718-276-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number196376
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number196376
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: