Healthcare Provider Details

I. General information

NPI: 1003748575
Provider Name (Legal Business Name): SHAFIQ ABDALLAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 ANDERSON AVE
CLIFFSIDE PARK NJ
07010-1835
US

IV. Provider business mailing address

8616 LITTLE NECK PKWY
FLORAL PARK NY
11001-1429
US

V. Phone/Fax

Practice location:
  • Phone: 347-988-7243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04171800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: