Provider Demographics
NPI:1023280633
Name:LATIF A SHAIKH PC
Entity type:Organization
Organization Name:LATIF A SHAIKH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LATIF
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-936-4679
Mailing Address - Street 1:257 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2924
Mailing Address - Country:US
Mailing Address - Phone:607-936-4679
Mailing Address - Fax:607-936-4670
Practice Address - Street 1:257 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2924
Practice Address - Country:US
Practice Address - Phone:607-936-4679
Practice Address - Fax:607-936-4670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130124261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB82029Medicare UPIN
BA1379Medicare PIN