Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 111592 | NY |
NPI | 1003896564 |
---|---|
Provider Name | Dr. Bhadra B Shah |
First Address | New York, NY 10003-2746 |
Second Address | New York, NY 10003-2746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 19/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002011343 | (05) | NY |
964431 | BCBS (01) | NY |
C12495 | (02) |