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General NPI Number Information
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NPI Number | 1669774527
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Entity Type | Organization
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Legal Business Name | ROCKAWAY INTERNAL MEDICINE PLLC
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 14712 ROCKAWAY BLVD
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City | JAMAICA
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State | NY
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Zip | 11436-1634
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Country | US
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Telephone | 718-832-8844
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Fax |
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Provider Business Mailing Address
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Address Line | 14712 ROCKAWAY BLVD
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City | JAMAICA
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State | NY
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Zip | 11436-1634
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Country | US
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Telephone | 718-832-8844
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHIVA SHAMTOUB
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Credential |
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Telephone | 718-732-7744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 241306
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License Number State | NY
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