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General NPI Number Information
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NPI Number | 1790969343
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Entity Type | Organization
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Legal Business Name | MUKESH D. SHAH, OB-GYN P.C.
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 1656 CHAMPLIN AVE SUITE # 224
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City | UTICA
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State | NY
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Zip | 13502-4830
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Country | US
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Telephone | 315-724-4017
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Fax | 315-793-3689
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Provider Business Mailing Address
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Address Line | 1656 CHAMPLIN AVE SUITE # 224
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City | UTICA
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State | NY
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Zip | 13502-4830
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Country | US
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Telephone | 315-724-4017
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Fax | 315-793-3689
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | DR. MUKESH DHIRAJLAL SHAH
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Credential | M.D.
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Telephone | 315-724-4017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 165131
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License Number State | NY
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