MEDICARE: SHAH PLASTIC SURGERY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	119551	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1073137790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAH PLASTIC SURGERY PLLC

Provider Business Mailing Address
First Line	:	550 W 54TH ST APT 30C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-6056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	352 7TH AVENUE, UNIT 1503
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001
Country	:	US
Telephone Number	:	914-341-2702
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NILAY SHAH
Credential	:	MD
Telephone Number	:	914-341-2702

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	05/29/2020

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