Provider Demographics
NPI:1568549525
Name:SHAHATA, HANI LAOIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:HANI
Middle Name:LAOIZ
Last Name:SHAHATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:2125 RIVER RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1135
Practice Address - Country:US
Practice Address - Phone:518-831-2500
Practice Address - Fax:518-831-2510
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242021207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001RZ1OtherEMPIRE BLUECROSS
NY110625000012OtherFIDELIS
NY308712OtherSENIOR WHOLE HEALTH
NY02995513Medicaid
NY649058OtherGHI-HMO
NY9418120OtherAETNA
NY02831776Medicaid
NY9418120OtherAETNA
NY331833Medicare Oscar/Certification
NY308712OtherSENIOR WHOLE HEALTH