Provider Demographics
NPI:1740318237
Name:FAMILY MEDICAL PC
Entity type:Organization
Organization Name:FAMILY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-482-0431
Mailing Address - Street 1:4 PALISADES DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-482-0431
Mailing Address - Fax:518-446-0731
Practice Address - Street 1:4 PALISADES DR
Practice Address - Street 2:SUITE 130
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-482-0431
Practice Address - Fax:518-446-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01234844Medicaid
NYCC1652Medicare ID - Type Unspecified
E47936Medicare UPIN