Healthcare Provider Details

I. General information

NPI: 1659349520
Provider Name (Legal Business Name): PARAG SHETH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E. 98TH STREET 6TH FLOOR BOX 1240B
NEW YORK NY
10029
US

IV. Provider business mailing address

5 E. 98TH STREET 6TH FLOOR BOX 1240B
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-9469
  • Fax: 212-369-6389
Mailing address:
  • Phone: 212-241-9469
  • Fax: 212-369-6389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number175719-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: