Provider Demographics
NPI:1215956040
Name:KAMBIZ SHEKIB, MD PC
Entity type:Organization
Organization Name:KAMBIZ SHEKIB, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMBIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEKIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-410-2184
Mailing Address - Street 1:62 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1524
Mailing Address - Country:US
Mailing Address - Phone:516-410-2184
Mailing Address - Fax:516-482-3707
Practice Address - Street 1:179-43A HILLSIDE AVE.
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:516-410-2184
Practice Address - Fax:516-482-3707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208684207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty