Healthcare Provider Details

I. General information

NPI: 1508945916
Provider Name (Legal Business Name): BAHOOBAL KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 HAMILTON DR
ROSLYN NY
11576-3129
US

IV. Provider business mailing address

48 HAMILTON DR
ROSLYN NY
11576-3129
US

V. Phone/Fax

Practice location:
  • Phone: 516-747-7235
  • Fax: 516-248-8494
Mailing address:
  • Phone: 516-747-7235
  • Fax: 516-248-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number131741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: