1033222468 NPI number — DR. SHYAM CHANDRU SHIVDASANI M.D.

Table of content: MRS. LATINA MCMANUS CSW (NPI 1659073914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033222468 NPI number — DR. SHYAM CHANDRU SHIVDASANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIVDASANI
Provider First Name:
SHYAM
Provider Middle Name:
CHANDRU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033222468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 RENI RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANHASSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11030-1222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-869-3210
Provider Business Mailing Address Fax Number:
516-627-0464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 LOCKWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10801-4915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-235-6900
Provider Business Practice Location Address Fax Number:
914-235-7900
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  196192 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 196192 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3359089 . This is a "AETNA HMO ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01851505 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002918 . This is a "CONNECTICARE ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 196192 . This is a "HIP ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C2846 . This is a "PHS HEALTHNET ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5387184 . This is a "AETNA PPO ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 163AJ3 . This is a "EMPIRE BC/BS ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00311425 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: WP738 . This is a "OXFORD ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2592106 . This is a "GHI ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1033222468 . This is a "COMMERICAL CARRIERS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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