Healthcare Provider Details

I. General information

NPI: 1235326513
Provider Name (Legal Business Name): IMRAN SHAIKH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9742 102ND ST
OZONE PARK NY
11416-2618
US

IV. Provider business mailing address

9742 102ND ST
OZONE PARK NY
11416-2618
US

V. Phone/Fax

Practice location:
  • Phone: 917-403-6271
  • Fax:
Mailing address:
  • Phone: 917-403-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number264908
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number0101237455
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101237455
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number264908
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: