Provider Demographics
NPI:1033369137
Name:MAHMOOD A.SHAMSI,M.D.,P.A.
Entity Type:Organization
Organization Name:MAHMOOD A.SHAMSI,M.D.,P.A.
Other - Org Name:MAHMOOD A. SHAMSI,M.D.,P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAMSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-563-6630
Mailing Address - Street 1:1273 BOUND BROOK RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1490
Mailing Address - Country:US
Mailing Address - Phone:732-563-6630
Mailing Address - Fax:732-563-6733
Practice Address - Street 1:1273 BOUND BROOK RD
Practice Address - Street 2:SUITE 10
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1490
Practice Address - Country:US
Practice Address - Phone:732-563-6630
Practice Address - Fax:732-563-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA57994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
020126Medicare PIN