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General NPI Number Information
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NPI Number | 1073653390
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Entity Type | Organization
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Legal Business Name | P. BADER & N. GONDAL M.D. , P.C.
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 11247 QUEENS BLVD STE 209
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City | FOREST HILLS
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State | NY
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Zip | 11375-7417
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Country | US
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Telephone | 718-263-7766
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Fax | 718-544-1981
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Provider Business Mailing Address
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Address Line | 11247 QUEENS BLVD STE 209
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City | FOREST HILLS
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State | NY
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Zip | 11375-7417
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Country | US
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Telephone | 718-263-7766
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Fax | 718-544-1981
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL BRUCE BADER
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Credential | MD
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Telephone | 718-263-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 143018
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License Number State | NY
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