Provider Demographics
NPI:1912216938
Name:TAYEB, HAYTHUM OSAMA (MBBS)
Entity Type:Individual
Prefix:DR
First Name:HAYTHUM
Middle Name:OSAMA
Last Name:TAYEB
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE # 3850S
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:
Practice Address - Street 1:19 BRADHURST AVE STE 3850S
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-909-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3200382084E0001X, 2084N0400X, 2084B0040X
MA2474872084N0400X
261Q00000X, 282N00000X
MA245772390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282N00000XHospitalsGeneral Acute Care Hospital
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program