Provider Demographics
NPI:1982772216
Name:SADIKOT, SHABBIR (MD)
Entity Type:Individual
Prefix:
First Name:SHABBIR
Middle Name:
Last Name:SADIKOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 JERICHO TPKE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4532
Mailing Address - Country:US
Mailing Address - Phone:516-379-0870
Mailing Address - Fax:516-921-4668
Practice Address - Street 1:175 JERICHO TPKE
Practice Address - Street 2:SUITE 220
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4532
Practice Address - Country:US
Practice Address - Phone:516-379-0870
Practice Address - Fax:516-921-4668
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01866480Medicaid
G78121Medicare UPIN
NY01866480Medicaid