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General NPI Number Information
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NPI Number | 1669422572
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Entity Type | Individual
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Provider Name | MOHAMMAD A BILAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 80 MAPLE AVE
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City | SMITHTOWN
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State | NY
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Zip | 11787-3520
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Country | US
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Telephone | 631-265-5777
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Fax | 631-265-5797
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Provider Business Mailing Address
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Address Line | 75 N COUNTRY RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2119
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Country | US
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Telephone | 631-476-2767
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Fax | 631-473-0132
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 222725
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 1669422572
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License Number State | NY
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