Healthcare Provider Details

I. General information

NPI: 1548393150
Provider Name (Legal Business Name): VINAY J SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 WHITE PLAINS RD
BRONX NY
10472-4900
US

IV. Provider business mailing address

86 INVERNESS DR
KENDALL PARK NJ
08824-7012
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-6610
  • Fax: 718-829-9132
Mailing address:
  • Phone: 201-307-9671
  • Fax: 718-310-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number166833
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: