Provider Demographics
NPI:1649339318
Name:A SHATLA NEUROLOGY LLC
Entity type:Organization
Organization Name:A SHATLA NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:ABDELHADY
Authorized Official - Last Name:SHATLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-266-2078
Mailing Address - Street 1:210 OLD CAMPION RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413
Mailing Address - Country:US
Mailing Address - Phone:315-266-2078
Mailing Address - Fax:315-735-3910
Practice Address - Street 1:210 OLD CAMPION RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-266-2078
Practice Address - Fax:315-735-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2142562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02155131Medicaid
H40159Medicare UPIN
CC6570Medicare ID - Type Unspecified