Provider Demographics
NPI:1033248844
Name:SEJAL U SHAH DDS PC
Entity Type:Organization
Organization Name:SEJAL U SHAH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEJAL
Authorized Official - Middle Name:U
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-739-6961
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-0081
Mailing Address - Country:US
Mailing Address - Phone:718-739-6961
Mailing Address - Fax:718-739-6958
Practice Address - Street 1:8820 169TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4431
Practice Address - Country:US
Practice Address - Phone:718-739-6961
Practice Address - Fax:718-739-6958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048976-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17958OtherDORALDENTAL
NY02145619Medicaid