Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 131741 | NY |
NPI | 1508945916 |
---|---|
Provider Name | Dr. Bahoobal Kumar |
First Address | Roslyn, NY 11576-3129 |
Second Address | Roslyn, NY 11576-3129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2006 |
Last Update Date | 08/07/2007 |