Healthcare Provider Details

I. General information

NPI: 1346622420
Provider Name (Legal Business Name): MOHAMMED ABDULA AL SHALAL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

83 COOPER DR APT 1A
NEW ROCHELLE NY
10801-4719
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5874
  • Fax: 718-579-4836
Mailing address:
  • Phone: 469-583-2538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberS3347
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: