Provider Demographics
NPI:1053355776
Name:BAB NUCLEAR RADIOLOGY, PC
Entity type:Organization
Organization Name:BAB NUCLEAR RADIOLOGY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. PARTNER/RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BONHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-517-8006
Mailing Address - Street 1:300 JERICHO QUADRANGLE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2704
Mailing Address - Country:US
Mailing Address - Phone:516-874-8108
Mailing Address - Fax:516-320-8952
Practice Address - Street 1:CVS PLAZA
Practice Address - Street 2:355 BROADWAY
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701
Practice Address - Country:US
Practice Address - Phone:631-229-3100
Practice Address - Fax:631-789-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02558836Medicaid
NYCJ8322OtherRAILROAD MEDICARE
NYCJ8322OtherRAILROAD MEDICARE