Provider Demographics
NPI:1659431039
Name:BEGUM, SHAMIM A (MD)
Entity Type:Individual
Prefix:
First Name:SHAMIM
Middle Name:A
Last Name:BEGUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8742 168TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3628
Mailing Address - Country:US
Mailing Address - Phone:516-741-0402
Mailing Address - Fax:
Practice Address - Street 1:45 MALL DRIVE
Practice Address - Street 2:SUITE 1LIDDSO OF NY STATE,
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5700
Practice Address - Country:US
Practice Address - Phone:631-547-1761
Practice Address - Fax:631-424-5765
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02007954Medicaid
NY02007954Medicaid