Provider Demographics
NPI:1649478686
Name:M. SHAREEF NEUROLOGY, PC
Entity type:Organization
Organization Name:M. SHAREEF NEUROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:516-670-0700
Mailing Address - Street 1:1100 SHAMES DR
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1765
Mailing Address - Country:US
Mailing Address - Phone:516-693-0700
Mailing Address - Fax:516-693-0271
Practice Address - Street 1:158 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2988
Practice Address - Country:US
Practice Address - Phone:631-271-1206
Practice Address - Fax:631-271-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2259432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH89014Medicare UPIN