Provider Demographics
NPI:1164887865
Name:SHAKIL ALI VIRJEE DMD PC
Entity Type:Organization
Organization Name:SHAKIL ALI VIRJEE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKIL
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:VIRJEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:518-274-3424
Mailing Address - Street 1:1533 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2842
Mailing Address - Country:US
Mailing Address - Phone:518-274-3424
Mailing Address - Fax:518-274-3428
Practice Address - Street 1:1533 2ND AVE
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2842
Practice Address - Country:US
Practice Address - Phone:518-274-3424
Practice Address - Fax:518-274-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0409941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty