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General NPI Number Information
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NPI Number | 1144469586
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Entity Type | Organization
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Legal Business Name | PROFFESIONAL ANESTHESIA PHYSICIAN, P.C.
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Dates
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Enumeration Date | 02/09/2009
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Last Update Date | 02/09/2009
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Provider Practice Location Address
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Address Line | 83-40 WOODHEAVEN BLVD
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City | GLENDALE
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State | NY
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Zip | 11385
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Country | US
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Telephone | 718-849-8700
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Fax | 718-966-2307
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Provider Business Mailing Address
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Address Line | 400 STAFFORD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-2855
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Country | US
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Telephone | 718-966-2307
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Fax | 718-966-2307
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Authorized Official
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Title or Position | M.D.
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Name | DR. NABIL ELSHAMMAA
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Credential |
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Telephone | 917-763-0262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 199869
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License Number State | NY
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