1811033889 NPI number — KUMAR SHAH MD

Table of content: (NPI 1811033889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811033889 NPI number — KUMAR SHAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KUMAR SHAH MD
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:
KUMARPAL SHAH MD
Provider Other Organization Name Type Code:
5
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:
1811033889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 LIVINGSTON ST
Provider Second Line Business Mailing Address:
APT 2B
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11217-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-222-1065
Provider Business Mailing Address Fax Number:
215-261-1529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 LIVINGSTON ST
Provider Second Line Business Practice Location Address:
APT 2B
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11217-1034
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:
215-261-1529
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
KUMARPAL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN IN PRACTICE
Authorized Official Telephone Number:
718-222-1065

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: 0021517 . This is a "GHI PROVIDER NO" 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: 6635785002 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 139486 . This is a "HIP PROVIDER ID NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 67A03 . This is a "BLUE SHELD PROVIDER NO" 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: 139486 B21 . This is a "HEALTHFIRST PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com