Basic Information
| Provider Information | |||||||||
| NPI: | 1881757268 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANISH | ||||||||
| FirstName: | SHABBAR | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 DAVIS AVE FL 4 | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077534488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327490003 | ||||||||
| FaxNumber: | 7329740366 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 DAVIS AVENUE | ||||||||
| Address2: | HOPE TOWER 4TH FL. | ||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329740003 | ||||||||
| FaxNumber: | 7329740336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 25MA08350900 | NJ | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0182699 | 05 | NJ | MEDICAID | P00883886 | 01 | NJ | RR MCR PTAN | OTHER |