Healthcare Provider Details

I. General information

NPI: 1558360495
Provider Name (Legal Business Name): VIJAY P SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NATHAN D PERLMAN PLACE SUITE 12S34
NEW YORK NY
10003-3851
US

IV. Provider business mailing address

1900 HEMPSTEAD TPKE SUITE 500
EAST MEADOW NY
11554-1724
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2124
  • Fax: 212-420-3449
Mailing address:
  • Phone: 516-542-1090
  • Fax: 770-666-9097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number119384
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number119384
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number119384
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: