=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306044862
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BHADRA SHAH MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2007
-----------------------------------------------------
Last Update Date | 09/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 SECOND AVE SUITE 9
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-777-3920
-----------------------------------------------------
Fax | 212-614-9376
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 SECOND AVE SUITE 9
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-777-3920
-----------------------------------------------------
Fax | 212-614-9376
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BHADRA B SHAH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-777-3920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 111592
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------