Provider Demographics
NPI:1013198704
Name:BM VASCULAR SURGERY PC
Entity Type:Organization
Organization Name:BM VASCULAR SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BADHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-220-6995
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:516-220-6995
Mailing Address - Fax:
Practice Address - Street 1:7554 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2639
Practice Address - Country:US
Practice Address - Phone:516-220-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00223574Medicaid
NYC08013Medicare UPIN
NY00223574Medicaid
NYWSB781Medicare PIN