Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 037013 | NY |
Y | 213EG0000X | General Practice | 037013 | NY |
NPI | 1003952425 |
---|---|
Provider Name | Hemendra Hirachand Shah |
First Address | New Hyde Park, NY 11040-3519 |
Second Address | New York, NY 10029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00723708 | (05) | NY |
037013 | LIC # NY (01) | NY |