Provider Demographics
NPI:1255411047
Name:EUSUF, SHEIKH M (DDS)
Entity type:Individual
Prefix:
First Name:SHEIKH
Middle Name:M
Last Name:EUSUF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7312 35TH AVE
Mailing Address - Street 2:APT. A 24
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4241
Mailing Address - Country:US
Mailing Address - Phone:718-458-7945
Mailing Address - Fax:718-235-2813
Practice Address - Street 1:1219 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3411
Practice Address - Country:US
Practice Address - Phone:718-647-6057
Practice Address - Fax:718-235-2813
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0512961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9177580OtherDORAL
NY02553015Medicaid