Provider Demographics
NPI:1497219281
Name:ARSHAD, ADNAN S
Entity Type:Individual
Prefix:
First Name:ADNAN
Middle Name:S
Last Name:ARSHAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 S EDISON EXT
Mailing Address - Street 2:
Mailing Address - City:MONTAUK
Mailing Address - State:NY
Mailing Address - Zip Code:11954-5330
Mailing Address - Country:US
Mailing Address - Phone:631-668-1040
Mailing Address - Fax:631-772-6713
Practice Address - Street 1:49 SURREY CIR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2528
Practice Address - Country:US
Practice Address - Phone:631-772-6075
Practice Address - Fax:631-772-6713
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05363391344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05363391Medicaid