Provider Demographics
NPI:1306800057
Name:REGIONAL NEUROLOGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:REGIONAL NEUROLOGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TABADDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-655-9111
Mailing Address - Street 1:4234-1 BRONX BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2801
Mailing Address - Country:US
Mailing Address - Phone:718-515-4347
Mailing Address - Fax:718-653-8641
Practice Address - Street 1:4234 BRONX BLVD FRNT 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2669
Practice Address - Country:US
Practice Address - Phone:718-515-4347
Practice Address - Fax:718-653-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10599OtherHIP CMO
NY1279657OtherUNITED HEALTHCARE
NYP623258OtherOXFORD
NY0H1338OtherHEALTHNET
NY9603726003OtherCIGNA
NYRB0476N110OtherBLUE CROSS BLUE SHIELD
NY231955OtherMANGED HEALTHNET
NY01638462Medicaid
NY195905OtherHIP
NYP623258OtherOXFORD
NY0H1338OtherHEALTHNET
NY0H1338OtherHEALTHNET
NY1279657OtherUNITED HEALTHCARE