Provider Demographics
NPI:1124807169
Name:CLEAR VIEW NP IN PSYCHIATRY PC
Entity type:Organization
Organization Name:CLEAR VIEW NP IN PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:847-305-0810
Mailing Address - Street 1:600 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-5450
Mailing Address - Country:US
Mailing Address - Phone:847-305-0810
Mailing Address - Fax:
Practice Address - Street 1:4016 74TH ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5602
Practice Address - Country:US
Practice Address - Phone:718-682-7090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty