Provider Demographics
NPI:1073653390
Name:P. BADER & N. GONDAL M.D. , P.C.
Entity Type:Organization
Organization Name:P. BADER & N. GONDAL M.D. , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:BADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-263-7766
Mailing Address - Street 1:11247 QUEENS BLVD
Mailing Address - Street 2:STE 209
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7417
Mailing Address - Country:US
Mailing Address - Phone:718-263-7766
Mailing Address - Fax:718-544-1981
Practice Address - Street 1:11247 QUEENS BLVD
Practice Address - Street 2:STE 209
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7417
Practice Address - Country:US
Practice Address - Phone:718-263-7766
Practice Address - Fax:718-544-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143018207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20D771OtherPAUL BADER
NY191119OtherNASIR GONDAL
NY0898142OtherPAUL BADER
NY808821OtherNASIR GONDAL
NY143018OtherPAUL BADER
NYDS356OtherPAUL BADER
NY01598425Medicaid
NY00840157Medicaid
NY2050689OtherNASIR GONDAL
NYP379206OtherNASIR GONDAL
NY02821GMedicare ID - Type UnspecifiedPAUL BADER
NY0898142OtherPAUL BADER
NYF53726Medicare UPIN
NY01598425Medicaid