Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 231392 | NY |
N | 207QA0505X | Family Doctor - Adult Medicine | OS014477 | PA |
NPI | 1336282953 |
---|---|
Provider Name | Dr. Lisa Jitendra Shah |
First Address | Philadelphia, PA 19123-1531 |
Second Address | Philadelphia, PA 19123-1531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 30/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02706081 | (05) | NY |
231392 | LICENSE (01) | NY |
I34116 | (02) | NY |