=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881757268
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHABBAR F DANISH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2006
-----------------------------------------------------
Last Update Date | 11/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 DAVIS AVENUE HOPE TOWER 4TH FL.
-----------------------------------------------------
City | NEPTUNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-974-0003
-----------------------------------------------------
Fax | 732-974-0336
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 DAVIS AVE FL 4
-----------------------------------------------------
City | NEPTUNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07753-4488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-749-0003
-----------------------------------------------------
Fax | 732-974-0366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 25MA08350900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------