Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 0225560 | NY |
NPI | 1073574398 |
---|---|
Provider Name | Dr. Uday Niranjan Shah |
First Address | Muttontown, NY 11791-9662 |
Second Address | Elmhurst, NY 11373-2344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 18/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02355604 | (05) | NY |
H68268 | (02) |