Provider Demographics
NPI:1194097857
Name:DR SAM SHAHEM OBGYN PLLC
Entity type:Organization
Organization Name:DR SAM SHAHEM OBGYN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-921-5370
Mailing Address - Street 1:10031 4TH AVE
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8335
Mailing Address - Country:US
Mailing Address - Phone:718-921-5370
Mailing Address - Fax:718-921-9136
Practice Address - Street 1:10031 4TH AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8335
Practice Address - Country:US
Practice Address - Phone:718-921-5370
Practice Address - Fax:718-921-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty