Healthcare Provider Details

I. General information

NPI: 1609046150
Provider Name (Legal Business Name): ZIA H SHAH M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 RIVERSIDE DR STE M09
BINGHAMTON NY
13905-4112
US

IV. Provider business mailing address

161 RIVERSIDE DR STE M09
BINGHAMTON NY
13905-4112
US

V. Phone/Fax

Practice location:
  • Phone: 607-797-6363
  • Fax: 607-797-5487
Mailing address:
  • Phone: 607-797-6363
  • Fax: 607-797-5487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number199773
License Number StateNY

VIII. Authorized Official

Name: ZIA H SHAH
Title or Position: OWNER
Credential: M.D.
Phone: 607-797-6363