Provider Demographics
NPI:1164778130
Name:ABUL SHAHIDULLAH, M. D., MEDICAL OFFICE
Entity Type:Organization
Organization Name:ABUL SHAHIDULLAH, M. D., MEDICAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHIDULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:718-366-7999
Mailing Address - Street 1:899 WOODMERE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2735
Mailing Address - Country:US
Mailing Address - Phone:718-366-7999
Mailing Address - Fax:718-366-6468
Practice Address - Street 1:62 65 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2001
Practice Address - Country:US
Practice Address - Phone:718-366-7999
Practice Address - Fax:718-366-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187626261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical