Provider Demographics
NPI:1023042132
Name:SHETH, NITIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:NITIN
Middle Name:D
Last Name:SHETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SECOND AVE-SUITE 20
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2716
Mailing Address - Country:US
Mailing Address - Phone:212-780-0566
Mailing Address - Fax:212-780-0356
Practice Address - Street 1:303 SECOND AVE-SUITE-20
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2716
Practice Address - Country:US
Practice Address - Phone:212-780-0566
Practice Address - Fax:212-780-0356
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1552161208600000X
NJ25MA04605900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00848935Medicaid
B11264Medicare UPIN
NYA400018199Medicare PIN