Basic Information
| Provider Information | |||||||||
| NPI: | 1306166392 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENGELOUN | ||||||||
| FirstName: | NOR | ||||||||
| MiddleName: | SABAH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BENGELOUN | ||||||||
| OtherFirstName: | NOR | ||||||||
| OtherMiddleName: | SABAH | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9 ARISTA DR | ||||||||
| Address2: | |||||||||
| City: | DIX HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117464904 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 BROOKDALE PLAZA | ||||||||
| Address2: | BROOKDALE UNIVERSITY HOSPITAL AND MEDICAL CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112123198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2010 | ||||||||
| LastUpdateDate: | 06/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 2563691 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.