Provider Demographics
NPI:1841387123
Name:BHANA, MAHOMED S (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHOMED
Middle Name:S
Last Name:BHANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:16 KENDALL DRIVE
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-368-5251
Mailing Address - Fax:845-368-5937
Practice Address - Street 1:255 LAFAYETTE AVE
Practice Address - Street 2:GOOD SAMARITAN HOSPITAL BEHAVIOR HEALTH DEPT
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-368-5251
Practice Address - Fax:845-368-5937
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1486782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02753533OtherMEDICAID GROUP
NY00885983Medicaid
0007431395OtherAETNA
581B52OtherEMPIRE BCBS
NYWFW351OtherMEDICARE GROUP
NY00885983Medicaid
NY66F41FW351Medicare PIN