Provider Demographics
NPI:1629203443
Name:SHAZIA SAMI MEDICINE PC
Entity Type:Organization
Organization Name:SHAZIA SAMI MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAZIA
Authorized Official - Middle Name:ANDLEEB
Authorized Official - Last Name:SAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-805-3283
Mailing Address - Street 1:112-16 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418
Mailing Address - Country:US
Mailing Address - Phone:718-849-3338
Mailing Address - Fax:718-849-3166
Practice Address - Street 1:11216 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2451
Practice Address - Country:US
Practice Address - Phone:718-849-3338
Practice Address - Fax:718-849-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240847261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care