Healthcare Provider Details

I. General information

NPI: 1013576552
Provider Name (Legal Business Name): HEALTH SHARED PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BELMONT AVE
BROOKLYN NY
11212-6719
US

IV. Provider business mailing address

PO BOX 260108
BELLEROSE NY
11426-0108
US

V. Phone/Fax

Practice location:
  • Phone: 718-395-6444
  • Fax: 718-676-9557
Mailing address:
  • Phone: 718-395-6444
  • Fax: 718-676-9557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: IJAZ AHMAD
Title or Position: OWNER/CEO
Credential: MD
Phone: 718-789-4333