Healthcare Provider Details

I. General information

NPI: 1003376849
Provider Name (Legal Business Name): NEIL VIJAY SHAH MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7679
US

IV. Provider business mailing address

199 MOUNT EDEN PKWY FL 4
BRONX NY
10457-7703
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-5790
  • Fax:
Mailing address:
  • Phone: 718-518-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number337332-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number337332
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: