Provider Demographics
NPI:1811985047
Name:SHAMIM, SYED QAISER (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:QAISER
Last Name:SHAMIM
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 1:1283 STATE ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5005
Mailing Address - Country:US
Mailing Address - Phone:732-745-9025
Mailing Address - Fax:732-545-3423
Practice Address - Street 1:1283 STATE ROUTE 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5005
Practice Address - Country:US
Practice Address - Phone:732-745-9025
Practice Address - Fax:732-545-3423
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04115600207RG0100X
NJ25 MA04115600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1443305Medicaid
NJ1443305Medicaid
NJC55263Medicare UPIN