Provider Demographics
NPI:1669798351
Name:SHAISH, HIRAM
Entity type:Individual
Prefix:
First Name:HIRAM
Middle Name:
Last Name:SHAISH
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 1:64 E 97TH ST
Mailing Address - Street 2:APT 7
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7070
Mailing Address - Country:US
Mailing Address - Phone:646-549-4545
Mailing Address - Fax:
Practice Address - Street 1:64 E 97TH ST
Practice Address - Street 2:APT 7
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7070
Practice Address - Country:US
Practice Address - Phone:646-549-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2775322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology