1821431040 NPI number — SHUDHANSHU ALISHETTI M.D.

Table of content: SHUDHANSHU ALISHETTI M.D. (NPI 1821431040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821431040 NPI number — SHUDHANSHU ALISHETTI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALISHETTI
Provider First Name:
SHUDHANSHU
Provider Middle Name:
Provider Name Prefix Text:
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:
1821431040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 1ST AVE APT 903
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-5504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-529-9143
Provider Business Mailing Address Fax Number:
408-419-2656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11215-3609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-499-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2013

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: 207RA0001X , with the licence number:  301250 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: A133760 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: SA3232267556 . This is a "OTHER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".