Provider Demographics
NPI:1881756757
Name:SHAKIB, MANOUCHER (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MANOUCHER
Middle Name:
Last Name:SHAKIB
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WEST 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:212-604-9800
Mailing Address - Fax:212-242-4757
Practice Address - Street 1:20 WEST 13TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-604-9800
Practice Address - Fax:212-242-4757
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100766207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB15978Medicare UPIN
NY524411Medicare ID - Type Unspecified