Healthcare Provider Details

I. General information

NPI: 1467683797
Provider Name (Legal Business Name): SAMIRKUMAR J SHAH PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 JERUSALEM AVE
LEVITTOWN NY
11756-3754
US

IV. Provider business mailing address

54 LONG MEADOW DR
PITTSBURGH PA
15238-1864
US

V. Phone/Fax

Practice location:
  • Phone: 516-796-6160
  • Fax: 516-796-0214
Mailing address:
  • Phone: 412-760-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number251960
License Number StateNY

VIII. Authorized Official

Name: SAMIRKUMAR J SHAH
Title or Position: PRESIDENT
Credential: MD
Phone: 412-760-6492