MEDICARE: SHEIKH M EUSUF D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	051296	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9177580	OTHER	NY	DORAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255411047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEIKH M EUSUF D.D.S

Provider Business Mailing Address
First Line	:	7312 35TH AVE
Second Line	:	APT. A 24
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-4241
Country	:	US
Telephone Number	:	718-458-7945
Fax Number	:	718-235-2813

Provider Business Practice Location Address
First Line	:	1219 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-3411
Country	:	US
Telephone Number	:	718-647-6057
Fax Number	:	718-235-2813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	01/08/2021

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