Provider Demographics
NPI:1336182641
Name:ALSHAFIE, TAREK AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:AHMED
Last Name:ALSHAFIE
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:ONE WEST RIDGEWOOD AVENUE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-389-3700
Mailing Address - Fax:201-389-6191
Practice Address - Street 1:1 W RIDGEWOOD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2359
Practice Address - Country:US
Practice Address - Phone:201-389-3700
Practice Address - Fax:201-389-6191
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06880800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075680Medicare ID - Type Unspecified
G95401Medicare UPIN