Basic Information
Provider Information | |||||||||
NPI: | 1316912041 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHAUKAT | ||||||||
FirstName: | KAMRAN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 12 N 7TH AVE | ||||||||
Address2: |   | ||||||||
City: | MOUNT VERNON | ||||||||
State: | NY | ||||||||
PostalCode: | 105502026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9146648000 | ||||||||
FaxNumber: | 9146648015 | ||||||||
Practice Location | |||||||||
Address1: | 241 E MAIN ST | ||||||||
Address2: |   | ||||||||
City: | HUNTINGTON | ||||||||
State: | NY | ||||||||
PostalCode: | 117432917 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6318122873 | ||||||||
FaxNumber: | 9179794997 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/17/2006 | ||||||||
LastUpdateDate: | 09/17/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0105X | 178907 | NY | N |   | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand | 208600000X | 178907 | NY | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 01197653 | 05 | NY |   | MEDICAID |