Provider Demographics
NPI:1063636637
Name:SHAHIM, HOUSHANG (MD)
Entity Type:Individual
Prefix:DR
First Name:HOUSHANG
Middle Name:
Last Name:SHAHIM
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 1:505 E 79TH ST
Mailing Address - Street 2:APT 14M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0709
Mailing Address - Country:US
Mailing Address - Phone:914-493-8155
Mailing Address - Fax:914-493-1675
Practice Address - Street 1:20 PLAZA WEST
Practice Address - Street 2:CEDARWOOD HALL
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1681
Practice Address - Country:US
Practice Address - Phone:914-493-8155
Practice Address - Fax:914-493-1973
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1618552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02357817Medicaid
NYA98827Medicare UPIN
NY07E172Medicare PIN