1194816397 NPI number — SHAH MEDICAL GROUP LLP

Table of content: (NPI 1194816397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194816397 NPI number — SHAH MEDICAL GROUP LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAH MEDICAL GROUP LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SURENDRA AND MRUDULA SHAH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194816397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
528 OLD COUNTRY ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11803-4997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-822-4706
Provider Business Mailing Address Fax Number:
516-822-1373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
528 OLD COUNTRY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11803-4997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-822-4706
Provider Business Practice Location Address Fax Number:
516-822-1373
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
SURENDRALAL
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
516-822-4706

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  144360 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 133617 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 143360 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: 133617 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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