Provider Demographics
NPI:1508480716
Name:SUBEDI, IMONA (MBBS)
Entity Type:Individual
Prefix:
First Name:IMONA
Middle Name:
Last Name:SUBEDI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N COUNTRY ROAD, LEVEL 2 - CMO SUITE
Mailing Address - Street 2:MATHER HOSPITAL INTERNAL MEDICINE RESIDENCY PROGRAM
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-686-2517
Mailing Address - Fax:631-686-7651
Practice Address - Street 1:75 N COUNTRY ROAD, LEVEL 2 - CMO SUITE
Practice Address - Street 2:MATHER HOSPITAL INTERNAL MEDICINE RESIDENCY PROGRAM
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-686-2517
Practice Address - Fax:631-686-7651
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2022-08-16
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-03-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program