Provider Demographics
NPI:1912965419
Name:SHARMA, HITA (MD)
Entity Type:Individual
Prefix:
First Name:HITA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MARCUS DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4230
Mailing Address - Country:US
Mailing Address - Phone:631-391-8354
Mailing Address - Fax:631-454-4163
Practice Address - Street 1:14601 45TH AVE
Practice Address - Street 2:RM 302
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-670-4495
Practice Address - Fax:718-670-3161
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02106090Medicaid
H26777Medicare UPIN
NY0105KQMedicare ID - Type Unspecified