Provider Demographics
NPI:1376508119
Name:EL-SHAER, REHAM I (MD)
Entity Type:Individual
Prefix:DR
First Name:REHAM
Middle Name:I
Last Name:EL-SHAER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401
Mailing Address - Country:US
Mailing Address - Phone:845-309-7597
Mailing Address - Fax:845-331-0989
Practice Address - Street 1:301 HURLEY AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-309-7597
Practice Address - Fax:845-331-0989
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002092-1207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02573568Medicaid
NYA100099596OtherTPAN
NYA100099596OtherTPAN
NY232AC1Medicare ID - Type Unspecified