Healthcare Provider Details

I. General information

NPI: 1063829844
Provider Name (Legal Business Name): QAIS RADAIDEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

501 SEAVIEW AVE STE 200
STATEN ISLAND NY
10305-3400
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-5800
  • Fax: 718-226-7891
Mailing address:
  • Phone: 718-226-5800
  • Fax: 718-226-7891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-44090
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number33321
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number85470-20
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number346762
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD-44090
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: