Provider Demographics
NPI:1487837290
Name:NEW ROCHELLE MEDICAL
Entity Type:Organization
Organization Name:NEW ROCHELLE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-629-4987
Mailing Address - Street 1:55 HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1709
Mailing Address - Country:US
Mailing Address - Phone:914-629-4987
Mailing Address - Fax:
Practice Address - Street 1:140 LOCKWOOD AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4915
Practice Address - Country:US
Practice Address - Phone:914-636-5700
Practice Address - Fax:914-636-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherIRS TAX ID NUMBER
NY=========OtherIRS TAX ID NUMBER