NPIMap

Individual provider Active NPI

Abul B Shahidullah, MD

  • Internal Medicine Physician
  • Ridgewood, NY
National Provider Identifier
1063481778
Registry record updated Oct 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
187626 Issued in NY
Practice address
62-65 Forest Avenue
Ridgewood, NY 11385
Phone
(718) 366-7999
Fax
(718) 366-6468
NPI assigned
Mar 15, 2006
Last updated
Oct 15, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 187626 NY Primary
Gastroenterology Physician 207RG0100X 187626 NY

Addresses

Primary practice location

62-65 Forest Avenue
Ridgewood, NY 11385

Mailing address

62-65 Forest Ave
Ridgewood, NY 11385
Phone (718) 366-7999

Other identifiers 1

IdentifierTypeStateIssuer
01591217MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111110000629 NY Practitioner - Internal MedicinePractitioner - Gastroenterology 6305010224 Reassigns benefits to 1 organization
Practice locations: Ridgewood, NY

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Gastroenterology
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1752 Park Ave
New York, NY 10035-2811
Phone (646) 694-6680

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
New York City Health and Hospitals Corporation CurrentSince Jul 28, 2019 Accepting new patients
New York City Health and Hospitals Corporation Internal Medicine Current Accepting new patients
New York City Health and Hospitals Corporation Internal Medicine CurrentSince Jul 28, 2019 Accepting new patients
Moinul Haque Physician PC PastSince Apr 16, 2011 Accepting new patients
Abul Shahidullah, M. D., Medical Office Past Accepting new patients
Searingtown Anesthesia PC Past Accepting new patients

Locations

594 Albany Ave
Brooklyn, NY 11203
Phone (646) 694-6680

1752 Park Ave
#J
New York, NY 10035
Phone (646) 694-6680

50 Water St
Fl 3
New York, NY 10004

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: ashahidullah1175632@nychhc.direct-ci.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224028800000",
    "number": "1063481778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62-65 FOREST AVE",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "11385",
            "telephone_number": "718-366-7999",
            "fax_number": "718-366-6468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62-65 FOREST AVENUE",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "11385",
            "telephone_number": "718-366-7999",
            "fax_number": "718-366-6468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHIDULLAH",
        "first_name": "ABUL",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2008-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "187626",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "187626",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01591217",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgewood, NY

Sources for this page

Verify at the official NPI Registry.