Provider Demographics
NPI:1841252103
Name:SHALHOUB, ROBERT F (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:SHALHOUB
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 1:36 7TH AVE
Mailing Address - Street 2:SUITE 518
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6609
Mailing Address - Country:US
Mailing Address - Phone:646-638-3790
Mailing Address - Fax:212-604-8913
Practice Address - Street 1:36 7TH AVE
Practice Address - Street 2:SUITE 518
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6609
Practice Address - Country:US
Practice Address - Phone:646-638-3790
Practice Address - Fax:212-604-8913
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216387207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02236184Medicaid
NY8H7461Medicare PIN
NYH12241Medicare UPIN