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General NPI Number Information
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NPI Number | 1295377059
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Entity Type | Individual
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Provider Name | RUTU SHAH
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Gender | Female
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 5 HUDSON VALLEY PROFESSIONAL PLAZA
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City | NEWBURGH
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State | NY
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Zip | 12550
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Country | US
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Telephone | 845-562-5570
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Fax |
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Provider Business Mailing Address
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Address Line | 138 FOLTIM WAY
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City | CONGERS
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State | NY
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Zip | 10920-1424
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Country | US
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Telephone | 845-270-3359
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 061831
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 061831
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License Number State | NY
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