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General NPI Number Information
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NPI Number | 1871901298
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Entity Type | Organization
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Legal Business Name | GLEN OAK MEDICAL CARE PLLC
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 26205 HILLSIDE AVE
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City | FLORAL PARK
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State | NY
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Zip | 11004-1756
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Country | US
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Telephone | 516-270-4729
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Fax | 516-833-7470
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Provider Business Mailing Address
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Address Line | 126 BIRCH DR
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2320
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Country | US
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Telephone | 516-270-4729
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAIRA KHALID SHAHAB
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Credential | M.D.
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Telephone | 516-270-4729
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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 | 230853-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 230853-1
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License Number State | NY
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