Healthcare Provider Details

I. General information

NPI: 1700217783
Provider Name (Legal Business Name): HEMAL J. SHAH, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E 46TH ST 9TH FLOOR
NEW YORK NY
10017-2417
US

IV. Provider business mailing address

8 SPRUCE ST SUITE 69T
NEW YORK NY
10038-5245
US

V. Phone/Fax

Practice location:
  • Phone: 646-490-5475
  • Fax:
Mailing address:
  • Phone: 201-857-4011
  • Fax: 201-389-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number262631-1
License Number StateNY

VIII. Authorized Official

Name: DR. HEMAL J SHAH
Title or Position: PRESIDENT
Credential: MD
Phone: 201-857-4011