Provider Demographics
NPI:1962600734
Name:AL-JANABI, SHAKIR (MD)
Entity type:Individual
Prefix:DR
First Name:SHAKIR
Middle Name:
Last Name:AL-JANABI
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 1:367 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3107
Mailing Address - Country:US
Mailing Address - Phone:917-589-5421
Mailing Address - Fax:718-921-6299
Practice Address - Street 1:367 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3107
Practice Address - Country:US
Practice Address - Phone:917-589-5421
Practice Address - Fax:718-921-6299
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02350250Medicaid
NY02350250Medicaid
NYH82230Medicare UPIN