Healthcare Provider Details

I. General information

NPI: 1104791896
Provider Name (Legal Business Name): GATES MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 GATES AVE
BROOKLYN NY
11216-6488
US

IV. Provider business mailing address

8 FAIRFIELD RD
GREAT NECK NY
11024-1436
US

V. Phone/Fax

Practice location:
  • Phone: 917-940-3016
  • Fax:
Mailing address:
  • Phone: 917-940-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AFSHIN SHAHKOOHI
Title or Position: PRESIDENT
Credential: MD
Phone: 917-940-3016