Provider Demographics
NPI:1396997995
Name:NAEL, KAMBIZ (MD)
Entity type:Individual
Prefix:
First Name:KAMBIZ
Middle Name:
Last Name:NAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1 GUSTAVE L LEVY PLACE
Mailing Address - Street 2:BOX 1234
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-9870
Mailing Address - Fax:212-241-9970
Practice Address - Street 1:1 GUSTAVE L LEVY PLACE
Practice Address - Street 2:BOX 1234
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-9870
Practice Address - Fax:212-241-9970
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1073712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1073710Medicaid
CAEZ298ZMedicare PIN