Provider Demographics
NPI:1063789170
Name:SHAMRA MEDICAL LABORATORY LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:SHAMRA MEDICAL LABORATORY LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZERBASHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-888-0017
Mailing Address - Street 1:668 N BEERS ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1526
Mailing Address - Country:US
Mailing Address - Phone:732-888-0017
Mailing Address - Fax:732-888-0097
Practice Address - Street 1:668 N BEERS ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1526
Practice Address - Country:US
Practice Address - Phone:732-888-0017
Practice Address - Fax:732-888-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA072160000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty