Basic Information
| Provider Information | |||||||||
| NPI: | 1942792205 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GHULAMULLAH SHAHZAD MEDICAL PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 957 N 1ST ST | ||||||||
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| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110402821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182000720 | ||||||||
| FaxNumber: | 5167066026 | ||||||||
| Practice Location | |||||||||
| Address1: | 19303 UNION TPKE | ||||||||
| Address2: | |||||||||
| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113661874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167214648 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2018 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHAHZAD | ||||||||
| AuthorizedOfficialFirstName: | GHULAMULLAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 5167848331 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 261QE0800X | N | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy | 207ZP0102X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.