Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2001023255 | MO |
N | 111NI0900X | Internist | 2001023255 | MO |
N | 207R00000X | Internist | 248833-1 | NY |
N | 111NI0900X | Internist | 248833-1 | NY |
N | 207RG0300X | Geriatric Medicine | 248833-1 | NY |
N | 207RH0002X | Hospice and Palliative Medicine | 248833-1 | NY |
NPI | 1104892413 |
---|---|
Provider Name | Dr. Vipul L Shah |
First Address | Bronx, NY 10451-5504 |
Second Address | Bronx, NY 10451-5504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 29/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036115330 | (05) | IL |
248833-1 | NY STATE LICENSE (01) | NY |
H80812 | (02) | |
P00354535 | RAILROAD MEDICARE (01) |