MEDICARE: TUSHAR L SHAH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	219638	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548237571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TUSHAR L SHAH M.D.

Provider Business Mailing Address
First Line	:	2435 JEROME AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-6464
Country	:	US
Telephone Number	:	718-220-7677
Fax Number	:	718-220-7679

Provider Business Practice Location Address
First Line	:	2435 JEROME AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-6402
Country	:	US
Telephone Number	:	718-220-7677
Fax Number	:	718-220-7679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	01/13/2021

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