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General NPI Number Information
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NPI Number | 1649625369
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Entity Type | Individual
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Provider Name | LOAI DAHABRA
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Gender | Male
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 475 SEAVIEW AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3436
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Country | US
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Telephone | 718-226-8060
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Fax |
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Provider Business Mailing Address
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Address Line | 364 NAUGHTON AVE FL 2
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City | STATEN ISLAND
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State | NY
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Zip | 10305-2227
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Country | US
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Telephone | 917-865-3869
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 316876-01
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License Number State | NY
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