Physician Compare National (NPI:1396842092)

HEALTHCARE PROVIDER:

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1396842092
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3173562444
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050426001138
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SAINI
	Individual professional last name
Provider First Name	TARA
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1965
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	ADDICTION MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	ADDICTION MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	AHAVA MEDICAL OF BROOKLYN PC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	8123321510
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	35
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	11502 OCEAN PROMENADE
	Group Practice or individual's line 1 address
City	ROCKAWAY PARK
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	116942412
	Group Practice or individual's zip code (9 digits when available)
Phone Number	71895188002102
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M