Provider Demographics
NPI:1982443073
Name:SHAHID, MOHAMMED HASAN
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:HASAN
Last Name:SHAHID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 BAY RIDGE PKWY FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2401
Mailing Address - Country:US
Mailing Address - Phone:917-676-8883
Mailing Address - Fax:
Practice Address - Street 1:6 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2108
Practice Address - Country:US
Practice Address - Phone:516-656-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP125348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty