Provider Demographics
NPI:1104040369
Name:QADRI, SYED SHAH HASANUDDIN (MD)
Entity Type:Individual
Prefix:
First Name:SYED SHAH
Middle Name:HASANUDDIN
Last Name:QADRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26701 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1743
Mailing Address - Country:US
Mailing Address - Phone:718-343-7790
Mailing Address - Fax:
Practice Address - Street 1:26701 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1743
Practice Address - Country:US
Practice Address - Phone:718-343-7790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259223207RI0011X, 207RC0000X
AR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03415625Medicaid
NYG400070435Medicare PIN