Provider Demographics
NPI:1730234147
Name:SHUJAAT, ADIL (MD)
Entity type:Individual
Prefix:
First Name:ADIL
Middle Name:
Last Name:SHUJAAT
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 1:150 E 42ND ST FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5699
Mailing Address - Country:US
Mailing Address - Phone:646-605-8188
Mailing Address - Fax:212-523-7410
Practice Address - Street 1:36 WEST 60TH STREET
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2698
Practice Address - Country:US
Practice Address - Phone:212-523-8672
Practice Address - Fax:212-265-3416
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267902207RC0200X, 207RP1001X
FLME106323207R00000X, 207RP1001X
MS19546207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04190534Medicaid
GA323968531AMedicaid
MS19546OtherLICENSE
FL0018663-00Medicaid
MS19546OtherLICENSE
NYJ400236975Medicare UPIN
FLP00818027Medicare PIN
FLCY946ZMedicare PIN