MEDICARE: DR. VIPUL L SHAH M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	248833-1	NY
2	207R00000X	Internal Medicine Physician	2001023255	MO
3	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	248833-1	NY
4	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	248833-1	NY
5	208M00000X	Hospitalist Physician	036115330	IL
6	208M00000X	Hospitalist Physician	2001023255	MO
7	208M00000X	Hospitalist Physician	248833-1	NY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00354535	OTHER		RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	248833-1	OTHER	NY	NY STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1104892413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIPUL L SHAH M.D.

Provider Business Mailing Address
First Line	:	234 E 149TH ST STE 8D200
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5504
Country	:	US
Telephone Number	:	718-579-6027
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 E 149TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5504
Country	:	US
Telephone Number	:	718-579-6027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	07/21/2022

234 E 149TH ST STE 2A7
BRONX, NY
10451-5504

Practice Phone: 718-579-6672
Practice Fax: