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General NPI Number Information
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NPI Number | 1609296508
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Entity Type | Individual
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Provider Name | GULRU SHARIFOVA
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Gender | Female
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Dates
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Enumeration Date | 04/18/2014
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 162 MCKINLEY ST
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-2625
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Country | US
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Telephone | 516-776-7820
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Fax |
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Provider Business Mailing Address
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Address Line | SOUTHSIDE HOSPITAL 301 E MAIN ST
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City | BAY SHORE
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State | NY
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Zip | 11706-8408
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Country | US
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Telephone | 516-776-7820
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 290158
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License Number State | NY
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