Provider Demographics
NPI:1386036507
Name:SHAIK, MAHAMMAD RAFI (PT)
Entity Type:Individual
Prefix:MR
First Name:MAHAMMAD
Middle Name:RAFI
Last Name:SHAIK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4019
Mailing Address - Country:US
Mailing Address - Phone:601-259-6576
Mailing Address - Fax:
Practice Address - Street 1:152 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-4019
Practice Address - Country:US
Practice Address - Phone:601-259-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist