Healthcare Provider Details

I. General information

NPI: 1295420958
Provider Name (Legal Business Name): YOUSUF HUSSAIN SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 RIVERSIDE DR
BINGHAMTON NY
13905-4246
US

IV. Provider business mailing address

169 RIVERSIDE DR
BINGHAMTON NY
13905-4246
US

V. Phone/Fax

Practice location:
  • Phone: 607-798-5111
  • Fax:
Mailing address:
  • Phone: 607-798-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number340573
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: