Provider Demographics
NPI:1467524777
Name:BADHEY, MOHAN
Entity Type:Individual
Prefix:
First Name:MOHAN
Middle Name:
Last Name:BADHEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 STIRRUP LN
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4417
Mailing Address - Country:US
Mailing Address - Phone:718-894-4200
Mailing Address - Fax:
Practice Address - Street 1:170 STIRRUP LN
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4417
Practice Address - Country:US
Practice Address - Phone:718-894-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119330208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00223574Medicaid
NY08320GMedicare PIN
NYC08013Medicare UPIN
NY00223574Medicaid