Active NPI
Sassan Shahmanesh, MD
- Surgery Physician
- Port Washington, NY
National Provider Identifier
1861728107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 090072
- Practice address
- 115 Links CT
Port Washington, NY 11050-4709 - Phone
- (516) 767-0069
- Fax
- (516) 767-0069
- NPI assigned
- Oct 21, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 090072 | NY | Primary |
Addresses
Primary practice location
115 Links CT
Port Washington, NY 11050-4709
Mailing address
115 Links CT
Port Washington, NY 11050-4709
Phone (516) 767-0069
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 090072 | Other | NY | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 090072 | NY | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256083200000",
"number": "1861728107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 LINKS CT",
"city": "PORT WASHINGTON",
"state": "NY",
"postal_code": "110504709",
"telephone_number": "516-767-0069",
"fax_number": "516-767-0069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 LINKS CT",
"city": "PORT WASHINGTON",
"state": "NY",
"postal_code": "110504709",
"telephone_number": "516-767-0069",
"fax_number": "516-767-0069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAHMANESH",
"first_name": "SASSAN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-21",
"last_updated": "2009-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NY",
"license": "090072",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "090072",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Washington, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.