Provider Demographics
NPI:1073065397
Name:SHALIMHAIEM, MENACHEM
Entity type:Individual
Prefix:
First Name:MENACHEM
Middle Name:
Last Name:SHALIMHAIEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3726
Mailing Address - Country:US
Mailing Address - Phone:718-377-0704
Mailing Address - Fax:
Practice Address - Street 1:4426 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1201
Practice Address - Country:US
Practice Address - Phone:718-854-0001
Practice Address - Fax:888-530-3797
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant