Provider Demographics
NPI:1063529576
Name:A LOUIS SHAHEEN MD PC
Entity type:Organization
Organization Name:A LOUIS SHAHEEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SHAHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-735-4447
Mailing Address - Street 1:102 EAGLE STREET
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-3902
Mailing Address - Country:US
Mailing Address - Phone:315-735-4447
Mailing Address - Fax:315-735-4071
Practice Address - Street 1:102 EAGLE STREET
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-3902
Practice Address - Country:US
Practice Address - Phone:315-735-4447
Practice Address - Fax:315-735-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038343208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00564250Medicaid
NY00564250Medicaid
C58645Medicare UPIN