Healthcare Provider Details

I. General information

NPI: 1326124777
Provider Name (Legal Business Name): MONTHER KAZEM SHARIF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE DEPT OF ANESTHESIA
BRONX NY
10457-7606
US

IV. Provider business mailing address

68 S SERVICE RD SUITE 350
MELVILLE NY
11747-2354
US

V. Phone/Fax

Practice location:
  • Phone: 718-466-8153
  • Fax: 718-518-5351
Mailing address:
  • Phone: 516-945-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number187170
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: