Provider Demographics
NPI:1861692287
Name:SHABTAI, ALLA ADI (RPA-C)
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:ADI
Last Name:SHABTAI
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3406
Mailing Address - Country:US
Mailing Address - Phone:718-542-0200
Mailing Address - Fax:718-542-0201
Practice Address - Street 1:1042 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459
Practice Address - Country:US
Practice Address - Phone:718-542-0200
Practice Address - Fax:718-542-0201
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011844363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861692287OtherNPI