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General NPI Number Information
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NPI Number | 1194816397
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Entity Type | Organization
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Legal Business Name | SHAH MEDICAL GROUP LLP
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 10/12/2010
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Provider Practice Location Address
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Address Line | 528 OLD COUNTRY ROAD
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City | PLAINVIEW
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State | NY
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Zip | 11803-4997
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Country | US
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Telephone | 516-822-4706
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Fax | 516-822-1373
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Provider Business Mailing Address
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Address Line | 528 OLD COUNTRY ROAD
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City | PLAINVIEW
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State | NY
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Zip | 11803-4997
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Country | US
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Telephone | 516-822-4706
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Fax | 516-822-1373
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Authorized Official
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Title or Position | MD
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Name | SURENDRALAL G. SHAH
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Credential | MD
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Telephone | 516-822-4706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 144360
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 133617
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 133617
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 143360
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License Number State | NY
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