Healthcare Provider Details

I. General information

NPI: 1174449888
Provider Name (Legal Business Name): LINCOLN MEDICAL AND MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST RM 820
BRONX NY
10451-5504
US

IV. Provider business mailing address

326 E 148TH ST
BRONX NY
10451-5770
US

V. Phone/Fax

Practice location:
  • Phone: 646-484-1247
  • Fax: 718-579-5874
Mailing address:
  • Phone:
  • Fax: 718-579-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: AMRU RESHAD SHAFI
Title or Position: PHYSICIAN
Credential: MD
Phone: 646-484-1247