MEDICARE: 1561 WESTCHESTER AVENUE MEDICAL OFFICES, PLLC

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	154855	NY

General Provider Information

NPI Number	:	1902035470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1561 WESTCHESTER AVENUE MEDICAL OFFICES, PLLC

Provider Business Mailing Address
First Line	:	1561 WESTCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-2912
Country	:	US
Telephone Number	:	718-842-8900
Fax Number	:	718-589-7952

Provider Business Practice Location Address
First Line	:	1561 WESTCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-2912
Country	:	US
Telephone Number	:	718-842-8900
Fax Number	:	718-589-7952

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PRAKASH H SHAH
Credential	:	M.D.
Telephone Number	:	718-842-8900

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	07/06/2009

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