Provider Demographics
NPI:1568766095
Name:SHAFI WANI,M.D.,P.C.
Entity Type:Organization
Organization Name:SHAFI WANI,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAFI
Authorized Official - Middle Name:
Authorized Official - Last Name:WANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-689-3005
Mailing Address - Street 1:2500 NESCONSET HWY
Mailing Address - Street 2:BUILDING 15H
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2555
Mailing Address - Country:US
Mailing Address - Phone:631-689-3005
Mailing Address - Fax:631-689-1750
Practice Address - Street 1:2500 NESCONSET HWY
Practice Address - Street 2:BUILDING 15H
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2555
Practice Address - Country:US
Practice Address - Phone:631-689-3005
Practice Address - Fax:631-689-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111748174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00201818Medicaid
C11834Medicare UPIN
NY00201818Medicaid