Basic Information
| Provider Information | |||||||||
| NPI: | 1184684714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LODI | ||||||||
| FirstName: | YAHIA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | YAHIA | ||||||||
| OtherFirstName: | ABUTACHER | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 425 ROBINSON ST | ||||||||
| Address2: | |||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139041735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077723535 | ||||||||
| FaxNumber: | 6077723536 | ||||||||
| Practice Location | |||||||||
| Address1: | 46 HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137902120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077294942 | ||||||||
| FaxNumber: | 6077297516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 10/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 217296 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084V0102X | 217296 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology |
ID Information
| ID | Type | State | Issuer | Description | 02080362 | 05 | NY | MEDICAID |