Provider Demographics
NPI:1033260609
Name:SAAD A. SHUKRI, M.D, PC
Entity Type:Organization
Organization Name:SAAD A. SHUKRI, M.D, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-447-8697
Mailing Address - Street 1:286 SILLS RD STE 3
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-8810
Mailing Address - Country:US
Mailing Address - Phone:631-447-8697
Mailing Address - Fax:631-447-0913
Practice Address - Street 1:286 SILLS RD STE 3
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8810
Practice Address - Country:US
Practice Address - Phone:631-447-8697
Practice Address - Fax:631-447-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty