Healthcare Provider Details

I. General information

NPI: 1275992034
Provider Name (Legal Business Name): ENDOCRINE TECHNOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HILTON AVE SUITE 17
HEMPSTEAD NY
11550-8115
US

IV. Provider business mailing address

230 HILTON AVE SUITE 17
HEMPSTEAD NY
11550-8180
US

V. Phone/Fax

Practice location:
  • Phone: 347-302-3107
  • Fax: 718-222-1350
Mailing address:
  • Phone: 347-302-3107
  • Fax: 718-222-1350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number139486
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number139486
License Number StateNY

VIII. Authorized Official

Name: DR. KUMARPAL AMBALAL SHAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 347-302-3107