Provider Demographics
NPI:1326055740
Name:SHAIKH, LATIF AZIZ (MD)
Entity Type:Individual
Prefix:
First Name:LATIF
Middle Name:AZIZ
Last Name:SHAIKH
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 1:257 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2924
Mailing Address - Country:US
Mailing Address - Phone:607-936-4679
Mailing Address - Fax:607-936-4670
Practice Address - Street 1:257 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2924
Practice Address - Country:US
Practice Address - Phone:607-936-4679
Practice Address - Fax:607-936-4670
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130124208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00596709Medicaid
NY16-476114OtherBCBS
RB7398Medicare PIN
NYB 82029Medicare UPIN