Provider Demographics
NPI:1215941620
Name:SHARMA, BRIJ MOHAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRIJ
Middle Name:MOHAN
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2125
Mailing Address - Country:US
Mailing Address - Phone:516-484-1333
Mailing Address - Fax:516-621-7158
Practice Address - Street 1:216 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2125
Practice Address - Country:US
Practice Address - Phone:516-484-1333
Practice Address - Fax:516-621-7158
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112575482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC07705Medicare UPIN