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Organization
FOREST HILLS PSYCHIATRIC PC
Active
Organization
FOREST HILLS PSYCHIATRIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAMA RASOOL MD (PSYCHIATRIST)
(718) 268-1100
Entity
Organization
Contact information
Practice address
76-03 113TH ST, FOREST HILLS, NY 11375-6585
(718) 268-1100
(718) 268-6418
Mailing address
76-03 113TH STREET, FOREST HILLS, NY 11375-6585
(718) 268-1100
(718) 263-6418
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
016036
NY
1041C0700X
Clinical Social Worker
Primary
R056338
NY
2084P0800X
Psychiatry Physician
159418
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00929204
—
NY
01
—
016036
DR MINI POTHEN LICENSE#
NY
01
—
159418
DR. RASOOL LICENSE#
NY
Enumeration date
12/06/2006
Last updated
05/07/2014
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