Provider Demographics
NPI:1669422572
Name:BILAL, MOHAMMAD A (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:A
Last Name:BILAL
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 1:75 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2119
Mailing Address - Country:US
Mailing Address - Phone:631-476-2767
Mailing Address - Fax:631-473-0132
Practice Address - Street 1:80 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3520
Practice Address - Country:US
Practice Address - Phone:631-265-5777
Practice Address - Fax:631-265-5797
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222725174400000X
NY16694225722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02672851Medicaid
I19612Medicare UPIN
NY722T91Medicare ID - Type Unspecified