Healthcare Provider Details

I. General information

NPI: 1285487124
Provider Name (Legal Business Name): REGAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120-152 48TH STREET 2FL
UNION CITY NY
07087
US

IV. Provider business mailing address

9108 63RD DR
REGO PARK NY
11374-3871
US

V. Phone/Fax

Practice location:
  • Phone: 646-631-6931
  • Fax:
Mailing address:
  • Phone: 646-631-6931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BORIS KHAIMOV
Title or Position: OWNER
Credential:
Phone: 646-631-6931