Healthcare Provider Details

I. General information

NPI: 1750315479
Provider Name (Legal Business Name): ESMAT SAAD SHAROBEEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CLOVE ROAD
STATEN ISLAND NY
10301-3627
US

IV. Provider business mailing address

441 9TH AVE CREDENTIALING 3RD FL
NEW YORK NY
10001-1623
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-6440
  • Fax: 718-816-3611
Mailing address:
  • Phone: 646-680-2894
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number163768
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: