1093995524 NPI number — KUMARPAL AMBALAL SHAH M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093995524 NPI number — KUMARPAL AMBALAL SHAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
KUMARPAL
Provider Middle Name:
AMBALAL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAH
Provider Other First Name:
KUMAR
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1093995524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
326 LIVINGSTON ST
Provider Second Line Business Mailing Address:
A
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11217-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-222-1065
Provider Business Mailing Address Fax Number:
718-222-1350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBERTSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11507-1010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-222-1065
Provider Business Practice Location Address Fax Number:
718-222-1350
Provider Enumeration Date:
11/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  139486 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 67A031 . This is a "MEDICARE ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00106064 . This is a "MEDICARE RAIL RD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0021517 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 340290101, IM . This is a "HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 340300201 END . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 139486 B21 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 139486 NY . This is a "1199" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 139486 . This is a "NY LICENSE NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6635785002 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 67A03 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2090111 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00770576 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139486 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 26121 . This is a "UNITED HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com