Provider Demographics
NPI:1942799366
Name:STATEN ISLAND MEDICAL & BEHAVIORAL PC
Entity Type:Organization
Organization Name:STATEN ISLAND MEDICAL & BEHAVIORAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TUZEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-596-0451
Mailing Address - Street 1:425 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1965
Mailing Address - Country:US
Mailing Address - Phone:917-596-0451
Mailing Address - Fax:
Practice Address - Street 1:31 NEW DORP LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2351
Practice Address - Country:US
Practice Address - Phone:917-596-0451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty