Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 25MA06903100 | NJ |
NPI | 1083718456 |
---|---|
Provider Name | Darsit Kanaiyalal Shah |
First Address | Tarrytown, NY 10591-5139 |
Second Address | Shrewsbury, NJ 07702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 24/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8198209 | (05) | NJ |
G48412 | (02) |