Provider Demographics
NPI:1356497713
Name:KALANI, BOB (MD)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:
Last Name:KALANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:KALANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6080 JERICHO TPKE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2850
Mailing Address - Country:US
Mailing Address - Phone:631-499-4490
Mailing Address - Fax:
Practice Address - Street 1:6080 JERICHO TPKE
Practice Address - Street 2:SUITE 312
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2850
Practice Address - Country:US
Practice Address - Phone:631-499-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1591622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF38145Medicare UPIN