Provider Demographics
NPI:1922436583
Name:RIDWAN SHABSIGH MD PC
Entity Type:Organization
Organization Name:RIDWAN SHABSIGH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OMRITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKHEERAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-378-0137
Mailing Address - Street 1:944 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0319
Mailing Address - Country:US
Mailing Address - Phone:212-249-6060
Mailing Address - Fax:212-988-1634
Practice Address - Street 1:944 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0319
Practice Address - Country:US
Practice Address - Phone:212-249-6060
Practice Address - Fax:212-988-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183329-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty