Healthcare Provider Details

I. General information

NPI: 1679540173
Provider Name (Legal Business Name): SHERIF HEIBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE DEPT OF
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL 1141
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2000
  • Fax:
Mailing address:
  • Phone: 212-241-5998
  • Fax: 212-241-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number213637
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: