=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073647921
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOMENS MEDICAL HEALTH CHECK UP PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 334 86TH STREET
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-745-7172
-----------------------------------------------------
Fax | 718-745-6082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 334 86TH STREET
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-745-7172
-----------------------------------------------------
Fax | 718-745-6082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | AYMAR A SHAHINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-745-7172
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------