1598717324 NPI number — DR. ABRAR H SHAH MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598717324 NPI number — DR. ABRAR H SHAH MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SHAH

Provider First Name:

ABRAR

Provider Middle Name:

H

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

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:

1598717324

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/27/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2365 S. CLINTON AVENUE

Provider Second Line Business Mailing Address:

SUITE 100

Provider Business Mailing Address City Name:

ROCHESTER

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

14618

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

585-723-7872

Provider Business Mailing Address Fax Number:

585-723-7236

Provider First Line Business Practice Location Address:

101 CANAL LANDING BLVD.

Provider Second Line Business Practice Location Address:

SUITE 8

Provider Business Practice Location Address City Name:

ROCHESTER

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

14618

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

585-442-5320

Provider Business Practice Location Address Fax Number:

585-442-5526

Provider Enumeration Date:

05/17/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  219972 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0000X , with the licence number: 219972 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0001X , with the licence number: 219972 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000922327002 . This is a "HEALTHNOW" identifier . This identifiers is of the category "OTHER".
• Identifier: P020219972 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 118208BO . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 2591709 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
• Identifier: 5450484 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 9717339 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
• Identifier: 7501538 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 1136019WCIMCD . This is a "WORKER'S COMPENSATION" identifier . This identifiers is of the category "OTHER".
• Identifier: P010219972 . This is a "BLUE CHOICE MANAGED CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 02498800 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".