Healthcare Provider Details

I. General information

NPI: 1205409331
Provider Name (Legal Business Name): CLINTON MEDICAL OFFICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 FULTON AVE
HEMPSTEAD NY
11550
US

IV. Provider business mailing address

390 FULTON AVE
HEMPSTEAD NY
11550
US

V. Phone/Fax

Practice location:
  • Phone: 516-280-2022
  • Fax:
Mailing address:
  • Phone: 516-280-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NASAR M SHAHID
Title or Position: OWNER
Credential: MD
Phone: 516-280-2022