Provider Demographics
NPI:1407184674
Name:AMMIR RABADI PHYSICIAN, PC
Entity Type:Organization
Organization Name:AMMIR RABADI PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMMIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:RABADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-476-8855
Mailing Address - Street 1:637 YONKERS AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-2630
Mailing Address - Country:US
Mailing Address - Phone:914-476-8855
Mailing Address - Fax:914-476-2033
Practice Address - Street 1:637 YONKERS AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-2630
Practice Address - Country:US
Practice Address - Phone:914-476-8855
Practice Address - Fax:914-476-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02962389Medicaid