Healthcare Provider Details

I. General information

NPI: 1336873017
Provider Name (Legal Business Name): SHOAIB NAWAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE RM 1215
NEW YORK NY
10029-7491
US

IV. Provider business mailing address

1901 1ST AVE
NEW YORK NY
10029-7491
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6271
  • Fax:
Mailing address:
  • Phone: 212-423-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number328341
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: