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NPI Code Detail

MEDICARE: BAKHTIAR SHAH MD PC

MEDICARE: BAKHTIAR SHAH MD PC
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
1207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1275728982
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAKHTIAR SHAH MD PC
Provider Business Mailing Address
First Line : 302 MANOR RD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-2408
Country : US
Telephone Number : 718-815-1000
Fax Number : 718-815-8122
Provider Business Practice Location Address
First Line : 130 AVENUE P
Second Line :
City : BROOKLYN
State : NY
Zip : 11204-6362
Country : US
Telephone Number : 718-815-1000
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. BAKHTIAR SHAH
Credential : M.D.
Telephone Number : 718-815-1000
Provider Enumeration Date : 09/06/2007
Last Update Date : 09/06/2007

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