Individual provider Active NPI

Mustaq A Sheikh, M.D.

  • Internal Medicine Physician
  • Norwich, NY
National Provider Identifier
1356422349
Registry record updated Jan 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
120820 Issued in NY
Practice address
179 N Broad St
Norwich, NY 13815-1019
Phone
(607) 337-4111
Fax
(607) 337-4049
NPI assigned
Oct 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 120820 NY Primary

Addresses

Primary practice location

179 N Broad St
Norwich, NY 13815-1019

Mailing address

179 N Broad St
Norwich, NY 13815-1019
Phone (607) 337-4111

Other identifiers 2

IdentifierTypeStateIssuer
00406464MedicaidNY
1767245MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050419000477 NY Practitioner - Geriatric MedicinePractitioner - Internal Medicine 6709867898 Practice locations: Waverly, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
120820NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chenango Memorial Hospital, Inc. Internal Medicine Past Accepting new patients
Fort Edward Rescue Squad Inc Past Accepting new patients
Chemung Medical Services PC Internal Medicine Past Accepting new patients
TTPM, Inc Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390953600000",
    "number": "1356422349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 N BROAD ST",
            "city": "NORWICH",
            "state": "NY",
            "postal_code": "138151019",
            "telephone_number": "607-337-4111",
            "fax_number": "607-337-4049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 N BROAD ST",
            "city": "NORWICH",
            "state": "NY",
            "postal_code": "138151019",
            "telephone_number": "607-337-4111",
            "fax_number": "607-337-4049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEIKH",
        "first_name": "MUSTAQ",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2014-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "120820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00406464",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1767245",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwich, NY

Sources for this page

Verify at the official NPI Registry.