Provider Demographics
NPI:1720299464
Name:HADI M. JABBAR, MD
Entity Type:Organization
Organization Name:HADI M. JABBAR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HADI
Authorized Official - Middle Name:M
Authorized Official - Last Name:JABBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:718-939-7743
Mailing Address - Street 1:5634 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5046
Mailing Address - Country:US
Mailing Address - Phone:718-939-7743
Mailing Address - Fax:
Practice Address - Street 1:5634 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5046
Practice Address - Country:US
Practice Address - Phone:718-939-7743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145455261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00765513Medicaid