Provider Demographics
NPI:1407065337
Name:SHAHIDA ABBAS MD LLC
Entity Type:Organization
Organization Name:SHAHIDA ABBAS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-836-0500
Mailing Address - Street 1:1451 ROUTE 88
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2320
Mailing Address - Country:US
Mailing Address - Phone:732-836-0500
Mailing Address - Fax:732-836-0502
Practice Address - Street 1:1451 ROUTE 88
Practice Address - Street 2:SUITE 12
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2371
Practice Address - Country:US
Practice Address - Phone:732-836-0500
Practice Address - Fax:732-836-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO64127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7753306Medicaid
NJ7753306Medicaid