Healthcare Provider Details

I. General information

NPI: 1508424466
Provider Name (Legal Business Name): SHOAIB ASHRAF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

18 HANOVER DR
DELMAR NY
12054-2240
US

V. Phone/Fax

Practice location:
  • Phone: 551-999-4849
  • Fax: 551-996-8089
Mailing address:
  • Phone: 518-898-8961
  • Fax: 551-996-8089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA11403800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA11403800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: