Provider Demographics
NPI:1619299328
Name:SHOMA B. ANAM
Entity Type:Organization
Organization Name:SHOMA B. ANAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHOMA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-556-5953
Mailing Address - Street 1:3715 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-1619
Mailing Address - Country:US
Mailing Address - Phone:347-556-5953
Mailing Address - Fax:
Practice Address - Street 1:3715 36TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-1619
Practice Address - Country:US
Practice Address - Phone:347-556-5953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614206-01314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility