Healthcare Provider Details

I. General information

NPI: 1003896564
Provider Name (Legal Business Name): BHADRA B SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BHADRA K SHROFF MD

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 SECOND AVE SUITE 9
NEW YORK NY
10003-2746
US

IV. Provider business mailing address

303 SECOND AVE SUITE 9
NEW YORK NY
10003-2746
US

V. Phone/Fax

Practice location:
  • Phone: 212-777-3920
  • Fax: 212-614-9376
Mailing address:
  • Phone: 212-777-3920
  • Fax: 212-614-9376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number111592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: