Provider Demographics
NPI:1376520213
Name:BAB NUCLEAR RADIOLOGY, PC
Entity Type:Organization
Organization Name:BAB NUCLEAR RADIOLOGY, PC
Other - Org Name:BAB RADIOLOGY HAUPPAUGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BONHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-517-8006
Mailing Address - Street 1:PO BOX 18005
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-8805
Mailing Address - Country:US
Mailing Address - Phone:631-517-8000
Mailing Address - Fax:631-893-1923
Practice Address - Street 1:521 ROUTE 111
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4370
Practice Address - Country:US
Practice Address - Phone:631-265-9645
Practice Address - Fax:631-265-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCJ8322OtherRAILROAD MEDICARE
NY02558836Medicaid
NYCJ8322OtherRAILROAD MEDICARE