Provider Demographics
NPI:1093040453
Name:SHADAB AHMED MEDICAL PC
Entity Type:Organization
Organization Name:SHADAB AHMED MEDICAL PC
Other - Org Name:SHADAB AHMED PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHADAB
Authorized Official - Middle Name:HUSSAIN
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-243-5515
Mailing Address - Street 1:53 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7162
Mailing Address - Country:US
Mailing Address - Phone:631-243-5515
Mailing Address - Fax:
Practice Address - Street 1:53 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7162
Practice Address - Country:US
Practice Address - Phone:631-243-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189464-1207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty