Provider Demographics
NPI:1518987791
Name:SHAMIM, TASNEEM F (MD)
Entity Type:Individual
Prefix:
First Name:TASNEEM
Middle Name:F
Last Name:SHAMIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TASNEEM
Other - Middle Name:F
Other - Last Name:SHAMIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1283 STATE HIGHWAY NO. 27
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-745-4844
Mailing Address - Fax:732-545-3423
Practice Address - Street 1:1283 ROUTE 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-745-4844
Practice Address - Fax:732-545-3423
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41521207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2066301Medicaid
NJ456132Medicare PIN
NJ2066301Medicaid