Provider Demographics
NPI:1346622420
Name:AL SHALAL, MOHAMMED ABDULA (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:ABDULA
Last Name:AL SHALAL
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 1:83 COOPER DR APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4719
Mailing Address - Country:US
Mailing Address - Phone:469-583-2538
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5874
Practice Address - Fax:718-579-4836
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295450207R00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital