Healthcare Provider Details

I. General information

NPI: 1306044862
Provider Name (Legal Business Name): BHADRA SHAH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 09/07/2011
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: DR. BHADRA B SHAH
Title or Position: PRESIDENT
Credential: MD
Phone: 212-777-3920