Provider Demographics
NPI:1538370929
Name:GIASHUDDIN, SHAH MOHAMMAD (MD)
Entity type:Individual
Prefix:DR
First Name:SHAH
Middle Name:MOHAMMAD
Last Name:GIASHUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAH
Other - Middle Name:MOHAMMAD
Other - Last Name:GIASHUDDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:77A POWERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2027
Mailing Address - Country:US
Mailing Address - Phone:917-376-5739
Mailing Address - Fax:
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:ROOM: 2047, DEPT. OF PATHOLOGY AND LAB. MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3609
Practice Address - Country:US
Practice Address - Phone:718-780-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238546-1207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02931753Medicaid
NYP00433258Medicare PIN
NY0076AGMedicare PIN