Provider Demographics
NPI:1285487124
Name:REGAL HEALTH LLC
Entity type:Organization
Organization Name:REGAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-631-6931
Mailing Address - Street 1:9108 63RD DR
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3871
Mailing Address - Country:US
Mailing Address - Phone:646-631-6931
Mailing Address - Fax:
Practice Address - Street 1:120-152 48TH STREET
Practice Address - Street 2:2FL
Practice Address - City:UNION CITY
Practice Address - State:NY
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:646-631-6931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty