Provider Demographics
NPI:1164927505
Name:KASBATI, KOMAL (MD)
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:
Last Name:KASBATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KOMAL
Other - Middle Name:
Other - Last Name:KASBATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:905 CORTELYOU RD APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5213
Mailing Address - Country:US
Mailing Address - Phone:909-955-4147
Mailing Address - Fax:
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311649208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics