1982849659 NPI number — DR. SYED ALI RAZA SHAMSI M.B.B.S.

Table of content: DR. SYED ALI RAZA SHAMSI M.B.B.S. (NPI 1982849659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982849659 NPI number — DR. SYED ALI RAZA SHAMSI M.B.B.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAMSI
Provider First Name:
SYED
Provider Middle Name:
ALI RAZA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.B.B.S.
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:
1982849659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3818 TEACHERS LN
Provider Second Line Business Mailing Address:
APT 12
Provider Business Mailing Address City Name:
ORCHARD PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14127-2132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-345-1747
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 E. FAIRMONT AVENUE
Provider Second Line Business Practice Location Address:
UNIT 7
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-526-4041
Provider Business Practice Location Address Fax Number:
716-526-4161
Provider Enumeration Date:
12/10/2008

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: 2084P0015X , with the licence number:  267162-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 267162-1 , 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)





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