Healthcare Provider Details

I. General information

NPI: 1508967498
Provider Name (Legal Business Name): TRUPTI SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1433
US

IV. Provider business mailing address

175 COMMUNITY DR
GREAT NECK NY
11021-5502
US

V. Phone/Fax

Practice location:
  • Phone: 718-147-0787
  • Fax: 718-470-9113
Mailing address:
  • Phone: 541-646-5190
  • Fax: 516-465-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number240931
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: