Provider Demographics
NPI:1730116344
Name:HAKIM, SHABBIR
Entity Type:Individual
Prefix:
First Name:SHABBIR
Middle Name:
Last Name:HAKIM
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 1:2157 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2648
Practice Address - Country:US
Practice Address - Phone:716-862-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1595562085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000510928011OtherBLUE SHIELD OF WESTERN NY
000510928016OtherBLUE SHIELD OF WESTERN NY
NY1595560WOtherWORKERS COMPENSATION
360004071OtherRAILROAD MEDICARE
NY01185088Medicaid
040426001902OtherFIDELIS
4903080OtherINDEPENDENT HEALTH
00010071904OtherUNIVERA
040426001901OtherFIDELIS
161362895OtherEMPIRE
P00066106OtherRAILROAD MEDICARE
DD6875Medicare PIN
161362895OtherEMPIRE
E42856Medicare UPIN