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General NPI Number Information
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NPI Number | 1164887865
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Entity Type | Organization
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Legal Business Name | SHAKIL ALI VIRJEE DMD PC
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 1533 2ND AVE
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City | WATERVLIET
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State | NY
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Zip | 12189-2842
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Country | US
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Telephone | 518-274-3424
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Fax | 518-274-3428
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Provider Business Mailing Address
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Address Line | 1533 2ND AVE
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City | WATERVLIET
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State | NY
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Zip | 12189-2842
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Country | US
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Telephone | 518-274-3424
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Fax | 518-274-3428
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAKIL ALI VIRJEE
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Credential | DMD
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Telephone | 518-274-3424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 040994
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License Number State | NY
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