Provider Demographics
NPI:1942655089
Name:SHAFAI, TAREQ ALI (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:TAREQ
Middle Name:ALI
Last Name:SHAFAI
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 KINGS HWY
Mailing Address - Street 2:2R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1348
Mailing Address - Country:US
Mailing Address - Phone:718-790-0517
Mailing Address - Fax:718-517-2242
Practice Address - Street 1:293 KINGS HWY
Practice Address - Street 2:2R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1348
Practice Address - Country:US
Practice Address - Phone:718-790-0517
Practice Address - Fax:718-517-2242
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY005512171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist