Provider Demographics
NPI:1992943609
Name:IJAZ SHAFI, MD, PC
Entity type:Organization
Organization Name:IJAZ SHAFI, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IJAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-224-7159
Mailing Address - Street 1:1 GROVE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-4116
Mailing Address - Country:US
Mailing Address - Phone:860-224-7159
Mailing Address - Fax:860-225-7122
Practice Address - Street 1:1 GROVE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-4116
Practice Address - Country:US
Practice Address - Phone:860-224-7159
Practice Address - Fax:860-225-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT015645207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010015645CT01OtherANTHEM
CT008008150Medicaid
CT0374470001Medicare NSC
CT010015645CT01OtherANTHEM
CTD100019831Medicare PIN