Provider Demographics
NPI:1326429044
Name:DABAGH, RANIA
Entity Type:Individual
Prefix:
First Name:RANIA
Middle Name:
Last Name:DABAGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 FRONT ST
Mailing Address - Street 2:APT 704
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1237
Mailing Address - Country:US
Mailing Address - Phone:917-282-4796
Mailing Address - Fax:
Practice Address - Street 1:1166 AVENUE OF THE AMERICAS
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-2708
Practice Address - Country:US
Practice Address - Phone:212-302-4889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008330152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist