Provider Demographics
NPI:1811061252
Name:CRESCENT DIAGNOSTIC PREVENTIVE & REHABLITATION MEDICAL PC
Entity type:Organization
Organization Name:CRESCENT DIAGNOSTIC PREVENTIVE & REHABLITATION MEDICAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABU
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-339-8950
Mailing Address - Street 1:52 HEYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2412
Mailing Address - Country:US
Mailing Address - Phone:718-339-8950
Mailing Address - Fax:718-339-8953
Practice Address - Street 1:52 HEYWOOD ST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2412
Practice Address - Country:US
Practice Address - Phone:718-339-8950
Practice Address - Fax:718-339-8953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2111612081P2900X, 2081S0010X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG79090Medicare UPIN