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General NPI Number Information
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NPI Number | 1104889484
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Entity Type | Organization
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Legal Business Name | JAY H AND VIJAYA J SHAH MD
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Dates
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Enumeration Date | 04/08/2006
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 2562 KNIGHTS RD
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City | BENSALEM
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State | PA
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Zip | 19020-3400
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Country | US
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Telephone | 215-244-6363
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Fax | 215-244-6365
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Provider Business Mailing Address
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Address Line | 862 SECOND STREET PIKE
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City | RICHBORO
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State | PA
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Zip | 18954-1005
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Country | US
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Telephone | 215-322-9292
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Fax | 215-322-4394
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Authorized Official
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Title or Position | PHYSICIAN-OWNER
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Name | JAY H SHAH
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Credential | MD
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Telephone | 215-322-9292
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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 |
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License Number State |
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