Healthcare Provider Details

I. General information

NPI: 1275614125
Provider Name (Legal Business Name): MUKESH SHAROHA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1822
US

IV. Provider business mailing address

300 BRETTONWOODS DR
CORAM NY
11727-3687
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5281
  • Fax: 718-604-5527
Mailing address:
  • Phone: 631-846-1603
  • Fax: 631-846-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number237417
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: