Basic Information
| Provider Information | |||||||||
| NPI: | 1750751236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MISHRIKY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 CORNWALLIS CT | ||||||||
| Address2: | |||||||||
| City: | MANALAPAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077267917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327184598 | ||||||||
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| Practice Location | |||||||||
| Address1: | 230 HILTON AVE STE 215 | ||||||||
| Address2: | |||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115508116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5265655556 | ||||||||
| FaxNumber: | 5164830396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2015 | ||||||||
| LastUpdateDate: | 09/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | MISHRIKY | ||||||||
| AuthorizedOfficialFirstName: | SHERIF | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7327184598 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 241400 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 02880817 | 05 | NY | MEDICAID | 070805000005 | 01 | NY | FIDELIS | OTHER |