Healthcare Provider Details

I. General information

NPI: 1750362380
Provider Name (Legal Business Name): ZIA H SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 RIVERSIDE DR SUITE M 09
BINGHAMTON NY
13905-4176
US

IV. Provider business mailing address

161 RIVERSIDE DR
BINGHAMTON NY
13905-4176
US

V. Phone/Fax

Practice location:
  • Phone: 607-797-6363
  • Fax: 866-546-2496
Mailing address:
  • Phone: 607-797-6363
  • Fax: 866-546-2496

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:
Title or Position:
Credential:
Phone: