Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MT191034 | PA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036132317 | IL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 276552 | NY |
NPI | 1245438928 |
---|---|
Provider Name | Roshan P Shah |
First Address | New York, NY 10032-3720 |
Second Address | New York, NY 10032-3729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 10/10/2014 |