Provider Demographics
NPI:1194469197
Name:NISHAT SHAHABUDDIN DMD PC
Entity Type:Organization
Organization Name:NISHAT SHAHABUDDIN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NISHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHABUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-757-0981
Mailing Address - Street 1:8552 168TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8552 168TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2652
Practice Address - Country:US
Practice Address - Phone:917-757-0981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1992319537OtherNPI
NY06285203Medicaid