MEDICARE: VIJAY P SHAH M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	119384	NY
2	207ZH0000X	Hematology (Pathology) Physician	119384	NY
3	207ZB0001X	Blood Banking & Transfusion Medicine Physician	119384	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A400061684	OTHER	NY	NGS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558360495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJAY P SHAH M.D.

Provider Business Mailing Address
First Line	:	1900 HEMPSTEAD TPKE
Second Line	:	SUITE 500
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-1724
Country	:	US
Telephone Number	:	516-542-1090
Fax Number	:	770-666-9097

Provider Business Practice Location Address
First Line	:	10 NATHAN D PERLMAN PLACE
Second Line	:	SUITE 12S34
City	:	NEW YORK
State	:	NY
Zip	:	10003-3851
Country	:	US
Telephone Number	:	212-420-2124
Fax Number	:	212-420-3449

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	02/20/2012

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Directions to “ VIJAY P SHAH M.D.” Practice Location

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