Healthcare Provider Details

I. General information

NPI: 1265723613
Provider Name (Legal Business Name): HUMAIRA SHOAIB M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270-05 76TH AVE. LIJ MEDICAL CENTER STAFF HOUSE ROOM 210B
NEW HYDE PARK NY
11040
US

IV. Provider business mailing address

270-05 76TH AVE. LIJ MEDICAL CENTER STAFF HOUSE, ROOM 210B
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-4650
  • Fax: 516-354-6491
Mailing address:
  • Phone: 718-470-4650
  • Fax: 516-354-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number281219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: