Provider Demographics
NPI:1811505100
Name:SHIBRAH M. JAMIL, MD, P.C.
Entity type:Organization
Organization Name:SHIBRAH M. JAMIL, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIBRAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-975-4163
Mailing Address - Street 1:15747 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2327
Mailing Address - Country:US
Mailing Address - Phone:917-975-4163
Mailing Address - Fax:
Practice Address - Street 1:11412 BEACH CHANNEL DR STE 10
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2212
Practice Address - Country:US
Practice Address - Phone:718-318-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain