Provider Demographics
NPI:1710128996
Name:SHAHZAD, GHULAMULLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:GHULAMULLAH
Middle Name:
Last Name:SHAHZAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2821
Mailing Address - Country:US
Mailing Address - Phone:516-784-8331
Mailing Address - Fax:516-704-2058
Practice Address - Street 1:19303 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366
Practice Address - Country:US
Practice Address - Phone:516-721-4648
Practice Address - Fax:516-717-3019
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252160207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology