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: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE # MSC30
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

2485 CEDAR SWAMP RD
GLEN HEAD NY
11545-3112
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-2179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: