Healthcare Provider Details

I. General information

NPI: 1164553012
Provider Name (Legal Business Name): MUNIR HUSSAIN SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST COLER-GOLDWATER SP. HOSPITAL & NURSING FACILITY
ROOSEVELT ISLAND NY
10044-0052
US

IV. Provider business mailing address

62 9TH ST
HICKSVILLE NY
11801-5448
US

V. Phone/Fax

Practice location:
  • Phone: 212-318-4038
  • Fax: 212-318-4037
Mailing address:
  • Phone: 212-318-4038
  • Fax: 212-318-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number211035
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: