Provider Demographics
NPI:1144313545
Name:SHEIKH, MOEEN HASAN
Entity type:Individual
Prefix:DR
First Name:MOEEN
Middle Name:HASAN
Last Name:SHEIKH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 SAINT PAULS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2126
Mailing Address - Country:US
Mailing Address - Phone:718-745-8295
Mailing Address - Fax:718-745-9899
Practice Address - Street 1:5702 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3805
Practice Address - Country:US
Practice Address - Phone:718-745-8295
Practice Address - Fax:718-745-9899
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0356791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00578592Medicaid