Healthcare Provider Details

I. General information

NPI: 1245442490
Provider Name (Legal Business Name): MOHAMMAD HUSSEIN ZGHEIB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 SOUTH AVE STE A
STATEN ISLAND NY
10314-3410
US

IV. Provider business mailing address

PO BOX 61507
STATEN ISLAND NY
10306-7507
US

V. Phone/Fax

Practice location:
  • Phone: 718-761-8800
  • Fax: 718-761-8804
Mailing address:
  • Phone: 718-761-8800
  • Fax: 718-761-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number257360
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA08580400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MA08580400
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number257360
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: