Provider Demographics
NPI:1144469586
Name:PROFFESIONAL ANESTHESIA PHYSICIAN, P.C.
Entity type:Organization
Organization Name:PROFFESIONAL ANESTHESIA PHYSICIAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHAMMAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-763-0262
Mailing Address - Street 1:400 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2855
Mailing Address - Country:US
Mailing Address - Phone:718-966-2307
Mailing Address - Fax:718-966-2307
Practice Address - Street 1:83-40 WOODHEAVEN BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-849-8700
Practice Address - Fax:718-966-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199869174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty