=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437438256
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NILAY G SHAH DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2011
-----------------------------------------------------
Last Update Date | 08/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 583 STATE ROUTE 32
-----------------------------------------------------
City | HIGHLAND MILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10930-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-928-3348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 MITCHELL AVE
-----------------------------------------------------
City | POUGHKEEPSIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12603-3423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0555691
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------