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General NPI Number Information
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NPI Number | 1831394469
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Entity Type | Organization
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Legal Business Name | HILLSIDE INFECTIOUS DISEASE CONSULTING PLLC
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 1575 HILLSIDE AVE STE 100A
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2501
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Country | US
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Telephone | 516-833-7469
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Fax | 516-833-7470
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Provider Business Mailing Address
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Address Line | 332 BRYN MAWR RD
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-3509
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Country | US
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Telephone | 516-270-4742
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. SAIRA K SHAHAB
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Credential | M.D.
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Telephone | 516-270-4742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 230853
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License Number State | NY
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