Provider Demographics
NPI:1881652055
Name:BAKOSS, IMAD J (MD)
Entity Type:Individual
Prefix:DR
First Name:IMAD
Middle Name:J
Last Name:BAKOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2165 71ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5526
Mailing Address - Country:US
Mailing Address - Phone:718-621-7100
Mailing Address - Fax:718-621-7103
Practice Address - Street 1:2165 71ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5526
Practice Address - Country:US
Practice Address - Phone:718-621-7100
Practice Address - Fax:718-621-7103
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129319207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00271187Medicaid
NY00271187Medicaid
NY332321Medicare ID - Type Unspecified