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General NPI Number Information
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NPI Number | 1073685301
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Entity Type | Organization
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Legal Business Name | SHRIRAJ SHAH PHYSICIAN PC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 99 E STATE ST MEDICAL ARTS BUILDING
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-1203
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Country | US
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Telephone | 518-725-7085
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Fax | 518-773-7999
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Provider Business Mailing Address
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Address Line | 99 E STATE ST MEDICAL ARTS BUILDING
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-1203
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Country | US
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Telephone | 518-725-7085
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Fax | 518-773-7999
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHRIRAJ C SHAH
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Credential | M.D.
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Telephone | 518-725-7085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 192319
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License Number State | NY
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