1336221696 NPI number — SHYAM C. SHIVDASANI, MD INTERNAL MEDICINE PLLC

Table of content: (NPI 1316596851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336221696 NPI number — SHYAM C. SHIVDASANI, MD INTERNAL MEDICINE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHYAM C. SHIVDASANI, MD INTERNAL MEDICINE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1336221696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2008
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:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHIVDASANI
Authorized Official First Name:
SHALEEN
Authorized Official Middle Name:
MAKHIJANI
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
516-242-1430

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 #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C2846 . This is a "HEALTHNET (PHS) #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1896297 . This is a "CIGNA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: WP738 . This is a "OXFORD #" 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: 0203874 . This is a "GHI NON-PAR #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 196192 . This is a "HIP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2592106 . This is a "GHI #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DE7187 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: SS6192 . This is a "ATLANTIS HEALTHPLAN #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 002918 . This is a "CONNECICARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5387184 . This is a "AETNA PPO #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 163AJ3 . This is a "EMPIRE BC/BS #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com