Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | N005855 | NY |
Y | 213ES0131X | Foot Surgery | N005855 | NY |
NPI | 1003951187 |
---|---|
Provider Name | Dr. Lisa Shah |
First Address | White Plains, NY 10607-1634 |
Second Address | New York, NY 10007-1207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 11/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U91346 | (02) | NY |