Basic Information
| Provider Information | |||||||||
| NPI: | 1568549525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAHATA | ||||||||
| FirstName: | HANI | ||||||||
| MiddleName: | LAOIZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 2125 RIVER RD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123091135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188312500 | ||||||||
| FaxNumber: | 5188312510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 01/18/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 242021 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 242021 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 001RZ1 | 01 | NY | EMPIRE BLUECROSS | OTHER | 110625000012 | 01 | NY | FIDELIS | OTHER | 308712 | 01 | NY | SENIOR WHOLE HEALTH | OTHER | 02995513 | 05 | NY | MEDICAID | 649058 | 01 | NY | GHI-HMO | OTHER | 9418120 | 01 | NY | AETNA | OTHER | 02831776 | 05 | NY | MEDICAID |